Possible causes of head tilt?

Question
QUESTION: Hi Dana!

I read your column a lot, and thought you might be the best person to turn to for this. I have a four year old Dutch lop who's suddenly developed a case of slight head tilt: prior to Saturday I didn't see anything, but on Sunday I began to see some unusual behavior. His head has begun to droop slightly to the left, and when it does, his right eye rolls a bit and he twitches to readjust himself (eye and head). The readjusting never works, so he keeps drooping and readjusting until he gets tired and lays his flat between his front paws - and the sleepier he gets, the more pronounced the head tilt becomes. His companion rabbit (an older Cinnamon) shows no symptoms, but does seem concerned about him and cleans him frequently. The most pronounced symptom seems to be lack of energy: he's usually very frisky and even wild, but now he just sits and looks confused. There hasn't been any gnashing or body rolling, and he's able to run and jump, just not very disposed to do so. I made him a vet appointment for tomorrow (Tuesday) morning, but I wanted to know what I should expect, what questions I should ask, and what I should insist on the vets checking for or performing. Any idea what he might have, and what are his prospects for recovery? I love my little guy, and I'm worried he might have a weak immune system: he's had a few minor ailments in the past, but they seem to come up pretty regularly. (The cinnamon, on the other hand, is never sick.)

Thanks so much for any help!

ANSWER: Dear Matvei,

The best source I can give you for complete information on this common problem is this one:

www.rabbit.org/health/tilt.html

But you can read my own account of dealing with head tilt bunnies here:

www.bio.miami.edu/hare/tilt.html

But you'll definitely need the help of a good rabbit vet:

www.rabbit.org/vets

The sooner he is seen and treatment begun, the better.  Even if the problem is slight, it will not likely get better on its own.  Rather, the reverse.  :(

Hope this helps.

Dana

---------- FOLLOW-UP ----------

QUESTION: Hi Dana!

Thanks for your reply. I got a diagnosis from the vet, read all the articles you listed, and have a couple more questions.

The vet said that the tests on my rabbit (Hucklebunny, or Buckles for short) came back positive for E. cuniculi, so we've kept him on 0.4cc of Panacur and 0.4cc of Baytril twice daily each. The odd thing is that I'm the only one who's ever seen Buckles manifest any head tilt or loss of balance: he spent a day at the vet's and two weeks with an experienced rabbit sitter while I was out of town, and neither of them noticed anything. (The rabbit sitter said that Buckles didn't seem to be eating his cecotropes - could this be a sign?)

So after reading the articles I guess I have two questions:

1) One article said that E. cuniculi usually causes more than head tilt -- "rabbits with head tilt caused by E. cuniculi will likely have at least one other sign of central disease such as weakness, paralysis, blindness, altered appetite, tremors or seizures" -- but I haven't seen any of these other signs in Buckles, except perhaps a slightly altered appetite and a sort of shyness he never used to have. (He was a wild, unruly bunny for a long time, but these days he mostly sits in his house or a corner. He and his girlfriend have a whole room to themselves, but he doesn't scamper around it much any more.) Since the article also said that many bunnies carry E. cuniculi without suffering from the bacteria, is there any chance that the inner ear infection was causing the head tilt and that the E. cuniculi might be latent but (at least temporarily) benign?

2) If he really does have E. cuniculi, what's the prognosis? The vet said I appeared to have caught this early.

3) Any tips for making sure he gets his medicine? He has plenty of fire when I try to actually pick him up, and when I try the passive approach (sneaking the syringe in between his side teeth when he's parked in his house) I'm never 100% sure I'm getting all of it into his mouth - it always seems like some goes in his chin fur or something - and I'm extremely worried that I'll mess up giving him his medicine and the bacteria will remain.  

Thanks for any help!

Answer
Dear Matvei,

"Since the article also said that many bunnies carry E. cuniculi without suffering from the bacteria, is there any chance that the inner ear infection was causing the head tilt and that the E. cuniculi might be latent but (at least temporarily) benign?"

Short answer: Yes.  Always a possibility.  But while many rabbits with severe manifestation of E. cuniculi-suspect problems may show multiple signs, it's not always the case if you catch things early.

"2) If he really does have E. cuniculi, what's the prognosis? The vet said I appeared to have caught this early."

Short answer:  If the head tilt really is due to E. cuniculi, it's impossible to know what will happen.  But if there is ear infection, it might get worse if the Baytril isn't the right choice for this particular bacterial population.

We've had many bunnies who had suspected E. cuniculi head tilts live for a full, complete, happy lifespan, some even with tiny, residual tilts.

3) Any tips for making sure he gets his medicine?

We always pick up the buns to give them their meds on a secure medicine table.  If your little guy is a WildBun, this might get progressively more challenging.  But you'll need to just hang out with him when you're *not* medicating and give him lots of reasons to trust you otherwise.  

It is important to get the whole dose into him, as you know.  So if it means a bit of manhandling in the short term, that's really what you have to try.

Hope this helps!

Dana