EMILIE ROYAUX DVM DipECVN MRCVS EUROPEAN AND RCVS RECOGNISED SPECIALIST IN VETERINARY NEUROLOGY

Emilie graduated from Ghent University in 2012 and completed a rotating internship and residency there. She received her ECVN diploma in 2017 and since then has been at Davies Veterinary Specialists.

Her veterinary webinar has the following objectives:

  • Anatomy of the vestibular system
  • Recognise the signs of vestibular disease
  • Differentiate central from peripheral vestibular disease
  • Make a list of differential diagnoses
  • Decide of further investigation is required
  • Treat the most common causes of vestibular disease

The vestibular system is the part of the nervous system responsible for balance. There are two components-Peripheral and Central. A colour schematic diagram illustrates these two components before moving on to the function of the vestibular system. This is described as balance, coordination of balance and gait, position and movement of the eyeballs and motion sickness. Malfunction is described as falling over, head tilt and ataxia, strabismus, nystagmus, and nausea and vomiting.

The next part of the webinar goes into more detail on the symptomatology of central and peripheral vestibular disease.

  • Head tilt
  • Vestibular ataxia
  • Falling over
  • Nystagmus
  • Positional strabismus
  • Nausea and vomiting

Each of these is then discussed in more detail with some very well structured word slides. Emilie speaks to these in a measured way, which prevented me from losing tract and also in flawless English. To give you an example, and taking head tilt as the symptom, we are advised that in peripheral vestibular disease the tilt is ipsilateral to the side of the lesion. With central vestibular disease head tilt is ipsilateral to the side of the lesion in brainstem lesions, but contralateral to the side of the lesion, (paradoxical), in cerebellar lesions. Not only are all the symptoms clearly described, there is an additional massive bonus with each sign accompanied with videos. These are quite simply superb.

A handy chart helps differentiate the direction of pathological nystagmus and correlation with peripheral, central and paradoxical vestibular disease. Similarly a word slide outlines the essential features of central compared to peripheral vestibular disease. Another chart summarises these and it would be very useful to be able to refer to the chart when confronted with a clinical case.

Clinical cases follow, and there are four of these, and each one has the same format. Following a brief description of the problem, there is a neurological examination (accompanied by more excellent videos.). You are invited, and given time, to suggest a neuro-anatomical diagnosis, and then a differential diagnosis. I liked the aide memoire VITAMIN CDE

V   vascular

I    infectious- inflammatory

T    traumatic –toxic

A    autoimmune

M   metabolic

I     iatrogenic-idiopathic 

C    congenital

D    degenerative

E     endocrine     

Once you have made your list of differentials further examinations are suggested. These, in all the cases, include some quite exceptional MRI or CT scans, each labelled with anatomical and pathological features of importance. A definitive diagnosis is made in all cases.  After treatment, follow up videos demonstrate the outcome.

Interspersed with these cases are mini quizzes to keep you on your toes. Also there is a very good description of Horner syndrome.

The most striking case for me was the a case of rostral cerebellar infarct in a dog, perfectly shown on the MRI scan.  As I mentioned before, however, all the clinical material shown is exceptional. The webinar ends with a case of metronidazole toxicity, again with before and after videos.  

This one of those webinars, whether you have a particular interest in neurology or not, you won’t want to miss. Everyone in small animal practice sees cases like the ones shown. It is rare to find a webinar on this particular subject that explains things so clearly, with great images and so well put together. Emilie is to be congratulated on her approach, which goes a long way to de-mystify a potentially very complicated subject