🌀 Rabbit Head Tilt (Vestibular Disease): Vet Causes, Treatment & Prognosis Guide 2025 🐰

By Dr Duncan Houston, BVSc

Head tilt in rabbits—also called wry neck or medically, vestibular disease—is a distressing but often treatable condition that affects a rabbit's balance and posture. Whether your bunny's head is tilted a few degrees or nearly upside down, prompt veterinary evaluation is critical. In this comprehensive 2025 vet guide, we’ll cover the causes, diagnostics, treatment, and prognosis of head tilt in pet rabbits. 🐇🧠

📚 What Is Rabbit Vestibular Disease?

Vestibular disease affects the balance center of the rabbit, and presents with symptoms like:

• 🌀 Persistent head tilt
• 🔁 Circling
• 💥 Loss of balance or falling over
• 👁️ Eye trauma (especially to the “down” eye)
• 🎯 Nystagmus (eye twitching)

This is not a standalone disease but a symptom of deeper issues—either in the inner ear (peripheral) or the brain (central). 🧠👂

🧠 Understanding the Anatomy

Peripheral System (Inner Ear):

• 🎧 Controls balance and hearing
• 🧭 Causes head tilt, circling, horizontal or rotary nystagmus
• ✅ Proprioception and limb strength remain intact

Central System (Brain Stem):

• 📍 Vestibular nuclei coordinate balance signals
• 🧠 Damage leads to head tilt, vertical nystagmus, weakness, seizures, or even death

🔍 Causes of Head Tilt in Rabbits

1️⃣ Otitis Interna (Inner Ear Infections):

• 🦠 Usually bacterial in origin
• 📸 Best diagnosed with CT/MRI (X-rays may miss it)
• 💊 Requires long-term antibiotics (3–6+ weeks)

2️⃣ Brain Disease (Central Vestibular Disease):

• 🧠 Includes encephalitis, abscesses, trauma, stroke
• ⚠️ Carries a worse prognosis

3️⃣ Encephalitozoon cuniculi (E. cuniculi):

• 🦠 A controversial protozoal parasite
• 📊 Serology tests exist but aren't definitive
• 💊 Treated empirically with fenbendazole or albendazole

4️⃣ Baylisascaris procyonis (Raccoon Roundworm):

• 🧬 Causes neurologic disease including tremors, seizures, death
• 🛡️ Prevention = no outdoor exposure to raccoon droppings

5️⃣ Other Causes:

• 💔 Stroke or vascular accident
• 🧬 Tumors or cancer
• 💊 Toxic exposure (e.g., heavy metals)
• 🔥 Heatstroke or metabolic disease

🩺 Diagnosing Head Tilt

📋 History Taking:

• 📅 Onset and duration of tilt
• 💊 Prior illness, trauma, or toxin exposure
• 🐾 Access to other sick rabbits

🧪 Diagnostic Tools:

• 🧠 Neurologic & ear exam
• 🩸 Bloodwork (CBC, biochemistry, heavy metals)
• 🧫 Serology for E. cuniculi (interpret with caution)
• 📸 Radiographs (middle/inner ear or trauma)
• 🧬 CT or MRI (gold standard for brain and ear imaging)

💊 Treatment Options

1️⃣ Antibiotics:

Used for bacterial inner ear infections—must be given for several weeks or longer. 📆💉

2️⃣ Anti-Parasitic Medications:

If E. cuniculi is suspected, fenbendazole, albendazole, or oxibendazole may be used. 🐛

3️⃣ Anti-Inflammatories:

• 💊 NSAIDs (e.g., meloxicam) reduce pain and inflammation
• 🚫 Avoid corticosteroids—may cause immunosuppression

4️⃣ Eye Protection:

Use lubricating drops or ointment to protect the “down” eye from injury or dryness. 👁️💧

5️⃣ Supportive Care:

• 🍼 Assist feeding if not eating
• 💦 Fluid therapy for hydration
• 🪵 Soft bedding or padded enclosures to prevent injury

6️⃣ Environmental Modification:

Keep the rabbit in a safe, enclosed, padded space. Reduce stress and eliminate obstacles. 🏠🛏️

📈 Prognosis

Peripheral Disease:

• ✅ Good to guarded prognosis
• ♾️ Residual head tilt may remain but rabbit can adapt and live normally

Central Disease:

• ⚠️ Guarded to poor prognosis
• 🧠 Risk of seizures, paralysis, or euthanasia if condition worsens

Recovery can take weeks to months. Many rabbits stabilize and adapt well with proper care. 🐇💚

📲 Get Help Early

If you notice head tilt, circling, or loss of balance in your rabbit, act fast. The earlier we begin treatment, the better the chances of recovery. Contact Dr Duncan Houston through AskAVet.com or the Ask A Vet app for urgent help. 📱🧑‍⚕️

🐰 Final Thoughts

Head tilt is scary, but not always fatal. With proper vet care, home support, and patience, many rabbits recover or learn to thrive with a tilted perspective on life. 🐇❤️🌀