A bunny with a head tilt is a very sad sight. Are we doing the right thing to keep him alive? Is he still happy? Will he ever be cured? These are the questions for most in our minds when one of our rabbits suddenly develops this problem.
What Are The Symptoms of Head Tilt?
Specific symptoms will depend on the individual rabbit and the root cause of the head tilt. However, general symptoms include:
- Tilted head
- Difficulty standing or moving
- Rolling or circling
- Rapid side-to-side eye movement (nystagmus)
- Hind end weakness or paralysis
Symptoms may appear very suddenly or develop gradually over time. In some cases, initial symptoms are almost imperceptible. However the condition is often progressive and recovery is dependent on early diagnosis and treatment. At the first sign of head tilt, get your rabbit to an experienced veterinarian immediately.
What Are the Common Causes of Head Tilt?
The causes of head tilt (also known as torticollis or wry neck) are numerous. A qualified rabbit veterinarian is the best person to diagnose. The two most common causes are a inner or middle ear infection or e. cuniculi infection.
Inner ear infection
An inner ear infection may have started with an outer ear infection, which remained unnoticed and untreated and gradually worked its way into the inner ear, or with a middle ear infection, which resulted from an upper respiratory infection. Or it may have arisen from bacteria in the nasal cavity or bloodstream. A radiograph of the head may help determine if the middle ears are affected. Some of the bacteria which have been cultured from ear infections are Staphylococcus sp, Pseudomonas aeruginosa, Pasteurella multocida, Bordetella bronchiseptica, Proteus mirabilis, Streptoccus epidermidis, Bacteroides spp. and Escherichia coli.
Treatment needs to be aggressive and prolonged. If exudate (pus) is found deep in the ear canal, a culture and sensitivity should be done in order to determine the bacterial agent and which antibiotics will be most effective in eliminating the infection. However, if it is impossible to access the bacteria in order to do the culture, many veterinarians will opt to treat with one of the antibiotics usually successful in curing an inner ear infection, such as enrofloxacin, chloramphenicol or penicillin G procaine with benzathaine. If no improvement is noticed after 4 weeks, a change in antibiotic is recommended.
If attempts to clear the infection with antibiotics appear to be failing, the veterinarian may suggest ear surgery to be able to obtain a sample for a culture and sensitivity, to remove exudate, and to provide drainage. Antibiotics need to be withheld for 3 days prior to obtaining a culture. One treatment includes leaving a drain. However, the exudate that rabbits produce is frequently very thick and does not drain.
If the head tilt is extreme, a steroid may be prescribed in an attempt to reduce the inflammation. If the rabbit is not eating or drinking, the doctor may recommend that fluids be administered subcutaneously and food given orally by syringe.
Although middle and inner ear infections reportedly have a poor cure rate, I know many cases of success in getting rabbits through this illness. The “secret” is long term antibiotics, frequently a minimum of 30 days. However it may be necessary for a rabbit to be on antibiotics for 6 months or even for the remaining years of his life. This treatment in conjunction with a loving and supportive environment can provide the rabbit with a good quality of life even if the disease cannot be completely eradicated.
Encephalitozoon cuniculi, a protozoan parasite, can cause brain disease (meningooencephalitis and microscopic cysts), and can result in paralysis anywhere in the body, since every part of the body is controlled by a specific part of the brain. (See the HRJ Vol. III No. 2 for a detailed description of this parasite.) Frequently there are signs preceding a head tilt caused by E.cuniculi such as tripping, dragging of feet, tipping over. These symptoms may have appeared and then vanished weeks or months prior to the head tilt. A blood test for antibodies to E. cuniculi can tell whether your rabbit has been exposed.
Other Causes of Head Tilt
Stroke is usually suspected on the basis of physical signs. Imaging to diagnose this problem is available to humans but difficult to arrange for companion rabbits. As in humans, acerbrovascular accident can kill, but if it does not, then the rabbit may initially be left with one side of his face, and perhaps one entire side of his body affected. One side of his face will droop, he may drool, and one eye may not function properly. He may not move normally or may move in circles. Function usually will slowly return over a period of months. Almost three years after a stroke, one of my rabbits has only a slight tilt to his head, unnoticeable, unless pointed out. Benny just looks a bit quizzical.
Care for a bunny who has suffered a stroke involves nursing him through his difficulties in eating, drinking and moving. Antibiotics do not help these cases, but sometimes are given to help rule out infection. Acupuncture should also be considered in treatment of these cases.
A blow to the face, neck or head can result in an injury to the brain which can cause the rabbit to have a head tilt. Trauma even could result from a panic reaction. Depending upon the severity of the trauma, an anti-inflammatory might be helpful to speed recovery.
Tumors occurring in the brain, neck or ear could produce a symptom of head tilt.
Cervical muscle contraction
A “muscle spasm” could cause a temporary head tilt. This situation will resolve itself once the muscle is relaxed.
Cerebral larva migrans
Baylisascaris spp are round worms which live in the intestine of raccoons and skunks. A rabbit may acquire eggs from these works by eating grasses, food, or bedding contaminated by feces. Larvae hatch from the eggs and migrate into the brain, where they live and grow and destroy brain tissue. There is no known cure for this invasion. Ivermectin probably does not penetrate the brain in sufficient quantities to kill the larvae, although it may kill them before they reach the brain.
This could be caused by ingestion of lead, found in paints or imported pottery, or ingestion of a toxic plant such as the woolly pod milkweed.
How Do I Care for a Rabbit with Head Tilt?
Regardless of the cause, most cases of head tilt have similarities, and a lot of supportive care will be needed. Here are some key issues to keep in mind.
Rolling and Lack of Balance
Lack of balance is what causes rabbits to “roll” and be unable to stand, so I try to pick them up as little as possible. When you must pick your rabbit up, hold him securely against your own body, to help him feel as stable as possible.
Depending upon the severity of the condition and your rabbit’s ability to remain upright, you may need to significantly modify your rabbit’s enclosure. Depending on the size of your rabbit you can usually figure out how to confine him to a smaller space (perhaps a laundry basket or sweater box with the higher sides). Line the bottom of the small enclosure with puppy pads, then on top add a layer of soft towels and finally a top layer of fleece/synthetic sheepskin that allows urine to pass through but will keep the bun dry. Then place rolled towels or small blankets along the sides to help prop him up, so that he will be less likely to roll when he loses his balance. A stuffed toy bunny friend also helps.
The “down” eye (the one facing the floor) will usually not close and will require eye ointment to keep the eye moist.
Feeding and Appetite
Most rabbits will keep eating but may need to be hand fed with lots of sympathy with every bite of food. He may not want his pellets, but he will usually eat a variety of fresh green veggies, carrots and fruits if you hold them for him. It may help to switch from timothy to alfalfa hay to encourage him to eat lots of roughage.
If your rabbit decides to decline food, you will have to be ready to syringe feed him. There are many recipes for syringe feeding and you can be fairly creative. The primary point is to get food into his stomach so that his gut doesn’t stop moving, which would add further complications to the process of getting him well. A sample recipe might be pellets mixed with 2 parts water, mixed garden baby food, some banana, some powdered acidophilus, some apple sauce (some of whatever he usually likes that has a strong taste). Feed him as frequently as possible throughout the day, and as much as you can get down him at each feeding. When he clenches his teeth and won’t swallow, stop for awhile and try more later.
While many cases of head tilt can be successfully treated, others cannot. Blackberry, a wonderfully large 3-year-old French lop, was adopted by a rabbit-loving family and lived happily in her humans’ two story house. Three years later, Blackberry was diagnosed with an inner ear infection. She was on antibiotics for months and went through various periods of syringe feeding. She was getting better all the while and then suddenly had a stroke. She fought that for another month and then died after another stroke. The postmortem exam showed that the inner ear infection she was fighting was almost cleared up. We don’t know why she also suffered a stroke, but Blackberry was a brave and valiant fighter, unwilling to let go of life without a battle.
Don’t Give Up!
Regardless of the cause, sometimes a rabbit who survives will be left with a slight head tilt for the rest of his life. I’ve found that while the rabbit will adjust rapidly, his caregiver is the one who may have more difficulty accepting the “cosmetics” of the situation. Rabbits are mighty fighters and you can help him in his fight by offering lots of sympathy and carrots.
Based on an article originally published in HRJ 3-8 by Sandi Ackerman, in consultation with Barbara Deeb, DVM, MS. Reformatted and Supportive Care Resources updated by Paige Parsons
More Head Tilt Articles From House Rabbit Society
- The Trouble with Ears: A Story of Head Tilt from the House Rabbit Journal
- Head Tilt in House Rabbits by Susan Brown DVM from the House Rabbit Journal
More Head Tilt Articles From Other Organizations
- Supportive Care for Head Tilt in Rabbits from disabledrabbits.com
- Head Tilt (Torticollis) in Rabbits: Don’t Give Up! by HRS Educator Dana M. Krempels, Ph.D at H.A.R.E, Inc.
- Physical Therapy for Rabbits with Torticollis (“Head Tilt”) by HRS Educator Dana M. Krempels, Ph.D at H.A.R.E, Inc.
Deeb, B.J., R.F. Di Giacomo, B.L. Bernard, and S.M. Silbernagel .1990. Pasteurella multocida and Bordetella Bronchiseptica infections in rabbits. J. Clinical Microbiol. 28:70-75.
Deeb, B.J., and R.F. Di Giacomo. 1994. Cerebral larva migrans caused by Baylisascaris sp. in pet rabbits. JAVMA.
Deeb, B.J. 1993. Update for veterinary practitioners on pasteurellosis in rabbits, JSEAM 2:112-113.
Fox, R.R., R.F. Norberg, and D.D. Myers. 1971. The relationship of Pasteurella multocida to otitis media in the domestic rabbit (oryctologus cuniculus) Lab Anim.Sci. 21:45-48.
Greene, C.E. and J.E. Oliver, Jr. 1983 Neurologic Examination. pp, 450-452 In S. J. Ettinger (ed.) Textbook of Veterinary Internal Medicine, 2nd ed W.B. Saunders Co., Philadelphia, PA.
Kunstyr, I., L. Lev, and S. Naumann. 1985. Head tilt in rabbits caused by pastuerellosis and encephalitozoonosis. Lab Anim. 19:208-213.
Kunstyr, I., and S. Naumann. 1986. Humoral antibody response of rabbits to experimental infection with Encephalitozoon cuniculi. Vet. Parasit. 21:223-232.
Kazacos, K.R., and W.M. Boyce. 1989. Baylisascaris larva migrans. JAVMA 195:894-903.
Kazacos, K.R., and E. A. Kazacos. 1988. Diagnostic exercise Neuromuscular condition in rabbits. Lab. Anim. Sci. 38:187-189
Mitchell, D, and E. Riggs. 1993. Sno-Wood Veterinary Hospital, Woodinville, WA. Personal communication.
Pakes, S.P. 1974. Protozoal Diseases pp. 273-278 in S.H. Weisbroth, R.E. Flatt, A.L. Kraus (eds.) . The Biology of the Laboratory Rabbit, Academic Press, Inc., Orlando, FL.
Smith, D. T., and L.T. Webster. 1925. Epidemiological studies on respiratory infections of the rabbit. VI Etiology of otitis media. J. Exp. Med. 41:275-283
Smith, D. T., and L.T. Webster. 1925.Epidemiological studies on respiratory infections of the rabbit. VI Etiology of otitis media. J. Exp. Med. 41:275-283.
Snyder, S.B., J.G. Fox, and O.A. Soave.1973. Subclinical otitis media associated with Pasteurella Multocida infection in New Zealand white rabbits (Oryctolagus cuniculus) Lab. Anim. Sci. 23:270-272.
Wilson, J.M. 1979. The biology of Encephalitozoon cuniculi. Med. Biol. 57:84-104.
I have a bunny who had head tilt for 5 years, after we moved to Europe, our veterinarian proposed experiment with plant drug Cerebrolysin. After a month on this treatment, 5 year old head tilt got reversed. This drug usually is given to people after stroke or anyone who has damaged neurological pathways. It’s basically rebuild them.