Neurological Issues (Seizures, Strokes, E.cuniculi etc.) - Symptoms and Care

[Wiebke]

1 Common neurological problems
- Disconcerting normal behaviours
- Neurological and CBS symptoms with more than one cause
- Seizures - symptoms and causes
- E.cuniculi
- Strokes
- CBS Syndrome/Walled-in Otitis Media (link)
2 Home care tips, welfare and end of life considerations



With great thanks to @PigglePuggle, who has researched and written this guide for The Guinea Pig Forum.

In this guide we will consider some other things which may initially present with similar symptoms to suspected CBS or that cause (or could be mistaken) for neurological symptoms.

These include:
- Disconcerting normal behaviours which an inexperienced owner may mistake for neurological problems
- Common CBS symptoms that can have different causes
- Neurological disorders: Seizures, E. cuniculi infection and Stroke


Disconcerting normal behaviours
It is quite common for a new and loving guinea pig owner to be very worried about which behaviours of guinea pigs are normal, and which are not. Two common aspects of normal guinea pig behaviour which are often mistaken for neurological problems are “popcorning”, and also sleeping.

Popcorning
Popcorning is a common and positive behaviour seen in happy and lively guinea pigs during play and social interactions, especially in youngsters or in males socialising with, or getting a pheromone sniff of, females. Popcorning is literally a guinea pig jumping of for joy, often they suddenly leap in the air and twitch their back legs, sometimes making a high pitched vocalisation. To the inexperienced this may look like a seizure, but if this occurs during excited play or in response to a companion or enjoyable enrichment source such as a favourite bed, or a pile of hay, and if normal activity resumes immediately, this is nothing to worry about and is a sign that your guinea pig is very happy. Some popcorning guinea pigs can literally bounce of walls and the floor - like every human dances differently, every guinea pig has their individual style of popcorning.

Sleeping
Sleeping may also disconcert an inexperienced owner, due to the normal guinea pig habit of sleeping with the eyes open. Perhaps the guinea pig is lying down with a somewhat glazed expression, and does not respond to you immediately- or they may sleep standing up, and appear as if they are unresponsive. Most sleeping guinea pigs can be gently roused by speaking to them in a happy friendly voice, or rustling a food bag, or rattling their food dish, in a familiar way- they should then wake up and reassure you that there was nothing more sinister going on than a nap.


Neurological and CBS symptoms that can have different causes

Head tilt and ear scratching/pawing
Head tilts are not just a symptom of CBS or another neurological problem.

Other causes can include:
- Ear infections. Untreated ear infections (outer, middle and inner ear) can cause permanent head tilts or kill.
- A build-up of wax in the outer ear (some piggies and breeds are more prone to this)
- E.cuniculi - only with rabbits in the same household or in possible contact with outdoors guinea pigs. Please be aware that the owner can also be the transmitter. Ideally, guinea pigs and rabbits are kept in different rooms and the guinea pigs are always fed, handled and cleaned first to minimise the risk of transmission from rabbits to guinea pigs.
- Rabbit ear mites (psoroptes cuniculi) - only in close proximity to rabbits (domestic or wild)
- Insects, hay or other things accidentally getting into the ear and causing discomfort or irritation

Please see a vet promptly with any head tilt; the chance of them correcting themselves is much higher if they are treated promptly. PLEASE never pour anything into an ear on spec; it can make things much worse and cause excruciating pain.

Sudden blindness
Please note that some cataracts or nuclear sclerosis (clouding over of the eye lens) can develop incredibly quickly in a matter of just a very few days. Some guinea pigs can be born blind without any outward signs or being lethals. If you suspect blindness, please see a vet for a check.
Guinea Lynx :: Eyes

Falling to the side and other mobility issues
You can see balance issues also in guinea pigs with other neurological issues (seizures, e.cuniculi or strokes).
More possible mobility issues are listed in the link below, which also details how you can best look after guinea pigs with mobility/balance/head lifting etc. issues.
Frailer guinea pigs or guinea pigs with arthritis can struggle with balance and struggle to get up if they fall over.
Looking after guinea pigs with limited or no mobility
Caring for Older Piggies and Facing the End - A practical and supportive information collection

Eyes: Runny eyes or missing blink / cleaning reflex / spilt cleaning fluid
A runny eye is primarily a sign of pain and discomfort, whether that is something getting into or stuck in the eye or a not ulcerating eye injury; they can also be a reaction to strong drafts, a sign of conjunctivitis and not just CBS. Please have runny eyes vet checked; especially is the eye is drawn in/smaller (often sign of an eye injury) or the watery tear fluid is constant or frequently recurring. Spilled or not fully reabsorbed milky-white tear fluid can occasionally happen without it being a problem.
A missing blink/clean reflex can also indicate a serious eye injury or be the result of a stroke. Please lubricate with plain artificial tear gel if possible (effect longer lasting, apply 3 times a dat) or plain artificual tear drops (apply up to 6 times a day).

One-sided face and body issues
One-sided facial or body responses can also be caused by a stroke.

Please make sure to check whether the eye on the affected side is hydrated/regularly cleaned and have the teeth check for one-sided dental overgrowth as a result of either a stroke, CBS or a brewing dental root or retrobulbar (behind the eye) abscess. Slanted incisors are often a first sign that one side of the mouth is used more for chewing, which can eventually lead to one sided dental overgrowth.
A vet check is recommended in any case.

Dental issues
Slanted, jagged or inwards pointing incisors can point to problem at the back like a brewing abscess or another pain issue, misalignment etc. and increasing dental overgrowth due to uneven chewing and no longer meeting and self-sharpen as a result of dental overgrowth.
Please keep in mind that the crucial back teeth are ground down by the very abrasive silica in grass/hay, which is the mainstay of a cavy diet and against which dental growth rate has evolved. Fibrous support feeding and timothy based recovery formulas replace mainly the ca. 75% hay/grass fibre in the diet and not the 20% of veg and fresh herbs.
Before suspecting CBS for dental overgrowth, please check whether you are actually overfeeding soft foods like veg, fruit or pellets, which does result in your piggies potentially not eating enough hay.

Gradual dental overgrowth (the premolars growing spurs) combines with other symptoms like increasingly slower chewing, picking up and dropping food that can no longer be chewed, preferring soft and then finely sliced foods like grass blades, fresh cilantro or finely sliced lettuce and eventually drooling (which in itself can indicate a number of issues that prevent the constantly produced saliva being swallowed or passing through the gut (dental spurs bridging/caging the tongue and inhibiting swallowing; heat stroke and pregnancy toxaemia and any blockages of the esophagus or gut). The change to a greater proportion of soft foods due to dental overgrowth can also lead to looser poos.
Please always switch from the normal life-long weekly weigh-in and body check (which should ideally include a quick look at the incisors) to weigh-in daily and stepping in with hay fibre based support feed.
Cavy dental savvy vets are sadly rare (it is not part of the curriculum) so please enquire and if in doubt preferably see an exotics vet. Non-veterinary DIY filing an burring can do permanent damage.

More information on feeding support:
All About Syringe Feeding and Medicating Guinea Pigs with Videos and Pictures
How to Improvise Feeding Support in an Emergency

Emergency and Crisis Care as well as Bridging Care until a Vet Appointment

 

[Wiebke]

Seizures - symptoms and causes
Seizures, usually defined as your guinea pig suddenly falling to one side and becoming unresponsive while making repetitive twitching movements, are a symptom rather than a diagnosis in itself.

Possible causes of seizures are:
- Epilepsy in guinea pigs (rare!)
In humans we often associate seizures with epilepsy, and although guinea pigs may suffer from epilepsy this is rather rare, and other causes of seizures should be explored and ruled out by your vet before this default diagnosis is settled upon. Some of the main causes of seizures are mange mite infestation, heat stroke, and poisoning.

- Mange mites (trixacarus caviae)
Mange mites are the most harmful of all guinea pig skin parasites, burrowing into the skin and causing severe irritation. Mild cases that are identified and treated immediately may resolve with no further problems than skin lesions and fur loss; however, severe cases of mange mites may result in seizures. If you suspect mange mites, a veterinary diagnosis is essential, and the vet will take a skin scrape to confirm the presence of mites in the skin. Mange mites can be treated with ivermectin, either as a spot-on treatment such as Xeno 450 (UK), where 3 doses are given, 2 weeks apart- or, in severe cases of mange mites, ivermectin injections may be your vet’s preferred treatment. It is worth noting that as the mites in the skin die, they may trigger a very dramatic immune response, and symptoms may initially get worse before they get better- this is the stage at which seizures are most likely to occur, especially in heavily infested animals from bad situations often further weakened by other forms of neglect such as poor diet and stress. Do NOT home treat on spec with pet shop products!
More information:
New Guinea Pig Problems: Sexing & Pregnancy; URI, Ringworm & Parasites; Vet Checks & Customer Rights
Guinea Lynx :: Mange Mites

- Heat stroke
Heat stroke may also cause guinea pigs to suffer seizures, as the brain overheats when the animal fails to regulate their body temperature. Guinea pigs are extremely prone to overheating, given their short legs, plump body shape, and inability to sweat. Even in the UK cases of heatstroke occur every summer at comparatively moderate temperatures because even half an hour in an exposed place or a hot room on a summer day can cause a guinea pig to overheat.
If you believe your guinea pig may be suffering from heat stroke, this is a veterinary emergency. The first sign may be lethargy, but this can progress to seizures and death very quickly. Emergency first aid should involve moving the piggy to the shade and a cool place, while gently cooling by sponging them with tepid, not very cold, water- especially the ears and feet, where most heat will be lost from, and offering small amounts of lightly chilled, not very cold or frozen, vegetables and drinking water. An emergency vet check is then essential to ensure no lasting damage has been done.
How to spot heat stroke, what to do and how to best prevent it:
Hot Weather Management, Heat Strokes and Fly Strike

- Poisoning
Poisoning is another possible cause of guinea pigs suffering from seizures. Pesticide poisoning is the most obvious source of neurological poisoning in many animals, but the most likely source of poisoning is your guinea pig accidentally eating common garden plants which contain toxic compounds. Many garden plants are toxic, and some may cause gut disturbances, affect the heart, or damage the liver- but some are acutely neurotoxic, and even small amounts may cause seizures, disorientation, uncoordinated movements, or paralysis. Some common examples of neurotoxic plants are rhododendron, cycads, horse chestnut, morning glory- but also some plants that are toxic to the liver and kidneys, such as lily plants, may also induce seizures where the liver and kidney damage causes metabolic waste products to accumulate in the blood and affect the brain function.
Suspected poisoning is of course a veterinary emergency, and it should be noted here that guinea pigs cannot vomit, so cannot expel any ingested poisonous food in the same way as other species can.
List Of Life And Death Out-of-hours Emergencies


E.cuniculi (Encephalitozoon cuniculi)
What is e.cuniculi?
E. cuniculi is a tiny single-celled parasite, most commonly affecting pet rabbits. While wild rabbits may carry the disease, they usually do not show symptoms and are less likely to be infected or infectious than pet rabbits. The parasite affects the nervous system, and also the kidneys. Baby rabbits who are born to infected mothers may also show eye damage.

How is it transmitted?
E. cuniculi is spread to guinea pigs primarily by contact with rabbit urine, as infected rabbits shed parasite spores in their urine. The parasite is very difficult to get rid of, so rabbits and guinea pigs should not share play areas, toys, bedding, cages etc. Thoroughly disinfecting potential rabbit urine contaminated items with a veterinary grade product such as F10, or even wiping floors and cages with bleach before rinsing thoroughly, is recommended, and if you have both rabbits and guinea pigs, always handling and feeding the guinea pigs first, and thoroughly washing and disinfecting your hands after feeding, handling or cleaning out rabbits, is also important.

Symptoms
Symptoms of E. cuniculi may be very similar to symptoms of inner ear infections, characterised initially by a head tilt and loss of balance. If the disease progresses untreated, seizures, paralysis and ultimately death may occur. Contact with rabbits is often the only indicator that this parasite may be an issue for guinea pigs.
If your guinea pig shows neurological symptoms and you have rabbits at home, or your guinea pig has boarded with or been cared for by someone who keeps rabbits, you should make your vet aware of this.

Testing for e.cuniculi
Definitive tests for E. cuniculi in rabbits involves blood or urine tests - however due to the invasive nature of blood sampling in guinea pigs, and the fact that they may be infected by the parasite without shedding infective spores, treatment and diagnosis are more likely to be based on the rabbit contact aspect.

Treatment
Treatment for E. cuniculi is fairly experimental and not always effective, but fenbendazole or albendazole, often prescribed as Panacur, is a recommended treatment that may kill the parasites and halt progression of the disease. Panacur comes in a range of formulations and it is very important that your vet prescribes an appropriate formulation for small animals- such as the medicine formulated for rabbits- at an appropriate dosage for the smaller size of guinea pigs. Beware of buying Panacur online and trying to guess the dosage yourself- this product is also available in formulations for sheep, cattle and horses, so please avoid any quick fix home medicating such as less reputable guinea pig websites may recommend, it could easily end in a fatal overdose! It should also be noted that this medicine does not provide any protection against future infections- it is metabolised in a couple of days at the most- the only protection against e. cuniculi infection, or re-infection after treatment, is scrupulous hygiene and avoiding contact with potentially infected rabbits.
Unfortunately, although treatment may kill the parasites and halt progression of the disease, the neurological damage is irreversible and even when recovered, your guinea pig may still have a head tilt and poor balance and co-ordination. It is important here to be honest with yourself, and discuss with your vet, what the quality of life is if the neurological damage is severe.


Stroke
What is a stroke?
A stroke is an event where blood supply to the brain is interrupted, often either by a blood clot, or a burst blood vessel. Symptoms of a mild stroke may be similar to symptoms of an inner ear infection, or E. cuniculi infection. Your guinea pig may have a head tilt, and appear rather uncoordinated and unable to balance.

How can it be diagnosed?
It is possible that a CT scan may be able to show if there is a clot or bleed on the brain, but realistically this may require sedation that could be risky, and facilities at a specialist exotic referral hospital which may be expensive or not immediately available, and as there is little that can be offered in the way of treatment, even if a stroke is confirmed, it is always worth considering how much you and your pet want to pursue a definitive diagnosis if it will not change the clinical outcome.

Stroke recovery and permanent damage
A mild stroke may be survivable, but leave your guinea pig with some mild mobility issues and a permanent head tilt- perhaps if the face is partially paralysed, adjustments to the diet such as chopping veg smaller, and offering recovery food or mushed up pellets in a syringe, may be required; perhaps removing ramps, steps, and any hard edges your guinea pig might fall against if their mobility and balance is affected.
As with humans, it is impossible to say always what caused a stroke, and if another will occur, or how complete the recovery might be. Be guided by your guinea pig’s quality of life, and your vet, and also by how much time you can realistically devote to nursing and syringe feeding long term, if after a couple of weeks you are not seeing your pet regain some independence.
Practical care tips for stroke survivors: Caring for Older Piggies and Facing the End - A practical and supportive information collection

 

[Wiebke]

2 Home care tips, welfare and end of life considerations

Many of the issues in this guide can sadly not be healed or successfully treated, so has to concentrate as much on your support at home and any necessary - if needed regular - veterinary care and medication for symptomatic relief.

Practical home care measures
At home, simple measures can make a big difference for comfort and minimising the risk of secondary problems for guinea pigs with mobility issues - from getting around to lifting their heads, wether that is arthritis or CBS.
These guides here contain lots of practical care tips as well as tips on what to look out for in terms of complications that arise from restricted mobility and staying more in one place:

Cage and comfort adaptions; monitoring for complications:
Looking after guinea pigs with limited or no mobility
Caring for Older Piggies and Facing the End - A practical and supportive information collection

Weight monitoring and feeding support:
Weight and Weight Loss Explained: BMI, Weighing, Poos and Feeding Support

End of life considerations
Unfortunately, with all uncurable and progressive problems you may have to face end of life decisions as your piggy' quality of life may gradually or suddenly decline.
If in any doubt, please follow your gut feeling and try to see things from your piggy's perspective if needed. The right time to let your piggy go is when they are no longer able to exercise normal behaviours like moving around and eating on their own, don't give clear signs that they still have interest in life and the will to go on, and when they are clearly in distress or pain that cannot be medically alleviated.

Please do not let your own fears of loss get in the way of your piggy's welfare. If you love somebody, then you will always find the strength in yourself to do what is needed, even where you cannot help yourself or you can organise support for yourself during that time and also support for yourself afterwards - it is out there. You can cry as much as you need afterwards but the knowledge that you have done the right thing for a beloved one will help you in the longer term.
The more you allow your fear of loss to rule you and run away with you, the harder and emotionally more devastating will the aftermath of a pet loss be on you. There is sadly no miracle cure that can magically prolong life or heal your piggy when it comes to neurological problems, but your insistence can easily prolong the suffering of your pet. 'Fair' does unfortunately not come into it - not for your piggy and not for you.

You are welcome to open an ongoing support thread in our End of Life and Bereavement Support Section to help you talk through all the issues so you can make any decisions with a clearer mind and support you during and in the wake of a loss or euthanasia/pts.
End of Life and Bereavement Support Corner

The guide link below will talk you in a sensitive and practical way through all the little and large questions that come up in this situation and will provide help during a very daunting time for you:
A Practical and Sensitive Guide to Dying, Terminal Illness and Euthanasia in Guinea Pigs

Support and pet bereavement resource links for adults, children and guinea pig companions after a loss:
Human Bereavement: Grieving, Coping and Support Links for Guinea Pig Owners and Their Children
Looking After a Bereaved Guinea Pig