Head tilts in rabbits

You are probably reading this article because out of the blue your beloved pet rabbit looks as if he or she has had a stroke. Perhaps you have come down one morning to find your beloved Binky is showing some of the following symptoms

  • Head tilt
  • Twisted neck (called wry neck or torticollis)
  • Flickering and rolling eyes (nystagmus and strabismus)
  • Unable to balance - goes into a non stop body roll and tailspin if you try to pick her up



Head tilts and balance problems are common in rabbits and one we see regularly at our rabbit friendly Veterinary Hospital. It is alarming and distressing and often your first reaction might be to beg your vet to 'put him out of his misery'. Many vets who don't treat rabbits regularly might agree with you. However before you panic and make a rash decision let us first discuss the two common causes of this condition and how they can be diagnosed and treated.

Inner ear disease

The first cause is a middle ear infection spreading down to the inner ear (tympanic bulla) where the balance canals (vestibular apparatus) are. People often assume that the infection comes from the external ear canal but more commonly rabbits commonly harbor bacteria called pasturella multocida or pseudomonas in their nasal passages and sinuses and it is very easy for this infection to pass up the Eustachian tube or blood stream into the inner ear. Pus in rabbits is thick and cheesy (caseous) so it can be very hard to shift infections if this glutinous pus builds up and fills the tympanic bulla.

Mild cases of middle / inner infection cause a head tilt. However when the balance canals (vestibular apparatus) are affected then the symptoms are much more severe. Rabbits develop a twisted neck and the eyes roll in their sockets. Severely affected cases go into a very distressing body roll and tailspin when handled, moved or stimulated by loud noises or sounds

The parasite Encephalitozoan cuniculi

The second cause is a protozoan intracellular parasite called Encephalitozoan Cuniculi (E. Cuniculi for short). This is a microscopic parasite which targets the brain, spinal cord and kidneys and cause chronic inflammation. Many normal healthy rabbits have this parasite but only a few will show clinical signs. When the parasite causes focal areas of inflammation in the brain it can cause central brain signs like an acute head tilt, twisted neck or the body roll.

 What can I do?

Rabbit with head tilt and balance issues need to be seen by a rabbit savvy vet as soon as possible to get the correct treatment started and find out the exact cause of the problem. We find it best to hospitalise these very sick rabbits during the acute phase for intensive nursing and veterinary care - once they are stable then we teach owners how to continue the care at home. However here are a few simple things you can do to keep your rabbit comfortable before travelling to your vet.

 Keeping your rabbit comfortable

Food and water

Often the rabbit is hungry and thirsty but just can't get to their food and water bowl due to severe balance and vertigo symptoms. It is important to offer them water from a bowl or a syringe and help them eat. Often they have no appetite for pellets but will eat favorite vegetables, fruits and treats if handfed very very slowly. If they are unable to eat on their own it is important you syringe feed them fibrous foods to keep the gut moving and stop gut stasis. You can try pureed rabbit pellets, liquidized veggies or a commercial convalescent food called Oxbow critical care for Herbivores. 

Secure comfortable bedding

You must provide a secure environment for your rabbit with plenty of surfaces to grip. Rabbits with a head tilt usually manage to get around quite well but if they have a twisted neck or body roll they can get bruised and sore when they go into a tailspin. Provide a secure padded area with fleeces and duvet so if they do roll over they won't get frightened or hurt themselves. Sometimes wrapping them up in a blanket (bunny burrito) helps reassure and calm them.

How do we diagnose the problem?

If there is active infection of the external ear we can take a swab of the pus to get it cultured - this will tell us what infection is present and the best antibiotic to kill the bacteria. Once the rabbit is stabilized we give the rabbit a light sedation of a valium type drug (midazolam) and get an x-ray of the base of the skull where the inner ear and balance canal are situated. A normal tympanic bulla should be filled with air and the cavity should appear black - if the bulla is filled with thick pus it may appear white (opacified). A cat scan of the area is the gold standard for diagnosis but is expensive and not always so readily available. We also take a blood test to see if there is active E. Cuniculi infection. The blood test checks for IgG and IgM antibodies which will tell if there is active E. cuniculi infection present. 


The first goal of treatment is to get the rabbit comfortable and able to eat and drink. Many rabbits that come to our hospital are often dehydrated, malnourished and have gut stasis so we have to give them intensive treatment to get them back on track. We also give them anti-inflammatory drugs and antibiotics. The best antibiotics are those targeted against pasturella and pseudomonas like enrofloxacin and long acting procaine benzyl penicillin (given by injection only). As the pus is hard to get rid off treatment may have to last for up to 3- 6 months. If the blood test comes back positive for active E. Cuniculi infection then we give a 28 course of an oral wormer medication called fenbendazole - this helps stops the shedding of the parasite.


 It does take some time for treatment to kick in so I always advocate patience. Some rabbits make a full recovery and lead normal lives; some get left with either a head tilt or wry neck but manage to get around and cope well with their disability. However cases that still have the body roll and balance issues even after 3 months of treatment often have poor quality of life and may need to be euthanased.


Coping with a rabbit with a head tilt can be very distressing for you, the rabbit and your family but dedication and perseverance is required. We find at our hospital that by getting a proper diagnosis and working with dedicated owners we can have some great success. As always we stress it is vital the rabbit has to have good quality of life and not suffer long-term.

Remember Just like people suffering a stroke there is no quick fix. Rabbits with head tilts and balance issues need time, patience, a rabbit savvy vet and a dedicated owner