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com

COMPANION ANIMAL PRACTICE Neurological conditions

such as head tilt can be
a challenge to manage

Common neurological and

musculoskeletal problems
in rabbits EMMA KEEBLE

NEUROLOGICAL and musculoskeletal disease is often encountered in pet rabbits, with head tilt and
hindlimb paresis/paralysis being the most common clinical presentations. Arthritis is also a frequent
finding in older animals. The principal causes of neurological disease in rabbits include bacterial infections,
such as pasteurellosis, encephalitozoonosis, trauma and toxaemia. Accurate case assessment and diagnosis
of neurological and musculoskeletal problems in this species can be a challenge for the veterinary surgeon
in practice. However, with the increased availability of advanced diagnostic imaging techniques, such as
computed tomography, obtaining a final diagnosis is a realistic goal. This article discusses the diagnostic
procedures that can be used to investigate neurological and musculoskeletal problems in rabbits, and
Emma Keeble outlines the causes and management options for the most common conditions seen.
graduated from
Bristol in 1994. After
a period in mixed
DIAGNOSTIC APPROACH The drugs discussed in this article are not licensed
practice, she
undertook an for use in rabbits, unless indicated, and the legal
internship in wildlife CLINICAL HISTORY implications of this should be borne in mind when
medicine at the
RSPCA wildlife A thorough clinical history, including details about diet, prescribing these products for pet rabbits.
hospital in Taunton. husbandry, behaviour, preventative medicine, previous
She subsequently
moved to Edinburgh, problems and in-contact animals, should be obtained.
where she is deputy Access to indoors may lead to ingestion of toxins (eg, disease. Recent stressors may also have occurred. A
head of the exotic
animal service, and
heavy metals). The recent introduction of a new rabbit or thorough description of the presenting complaint, includ-
lectures in exotic guinea pig will increase the likelihood of an infectious ing information about when and how the signs started,
animal and wildlife whether the animal appears in pain and whether the con-
medicine. She is also
a veterinary surgeon dition has altered since its onset, should be sought from
for Edinburgh Zoo. Assessment of pain the owner.
She holds the
RCVS certificate in Assessment of pain in rabbits is essential to deter-
zoological medicine.
mine the severity of the condition and formulate
CLINICAL EXAMINATION
A routine clinical examination should be performed,
a treatment plan. It is, however, extremely difficult
with initial observation at a distance to assess posture,
to assess pain in this species, except in severe cases
gait and mental status. This will determine if other body
where patients may vocalise. An animal with, for
systems are involved that could also affect the nervous
example, a fractured femur will attempt to disguise
system or influence the overall prognosis.
the injury to avoid being singled out by a predator.
A recent study conducted at the University of
Edinburgh to assess the efficacy of meloxicam as a
NEUROLOGICAL EXAMINATION
A full neurological examination should be carried out,
pre-emptive analgesic in rabbits undergoing elec-
including cranial nerve assessment, testing of postural
tive surgery concluded that it was extremely diffi-
reactions and spinal reflexes, and sensory evaluation.
cult to make an accurate assessment of pain in
Rabbits are prey species and therefore may not react as
rabbits in a clinical environment. Consequently, the
anticipated to stressful situations, so results should be
use of routine analgesia following surgery in this
interpreted with care.
species is highly recommended. Preoperative doses
of 0·6 mg/kg meloxicam either orally or by subcuta-
neous injection were found to be safe and effective
CLINICAL PATHOLOGY
In Practice (2006) A complete blood count, serum biochemistry and urina-
in rabbits (Parga 2003).
28, 212-218 lysis should be performed in all cases of neuromuscular

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A full ophthalmological examination is essential.

Phacoclastic uveitis following lens rupture has been
reported to occur secondarily to infection with Cranial nerve assessment should be carried out as part of
Encephalitozoon cuniculi in rabbits a full neurological examination

disease in rabbits. This is important to identify any nate the possibility of early infection prior to seroconver-
systemic disease that may manifest as a neurological sion. In clinical cases, however, a single negative result
abnormality. For example: rules out E cuniculi as a cause of disease. A positive or
■ Metabolic disorders such as renal failure/uraemic negative response in an individual animal only measures
encephalopathy, liver failure/hepatoencephalopathy and the presence of antibody at that particular time, which
electrolyte disturbances (eg, hypokalaemia); simply indicates exposure to the parasite; it does not
■ Infectious diseases such as Pasteurella multocida or reflect the course of the disease. For this, paired rising
Encephalitozoon cuniculi infection, or toxoplasmosis; antibody titres need to be demonstrated over a period of
■ Toxins; for instance, lead poisoning, which is classical- time.
ly associated with basophilic stippling and non-regenera-
tive anaemia. MICROBIOLOGY
In cases of suspected bacterial (eg, Listeria species)
SEROLOGY infection or fungal meningitis, urine, blood and cere-
Serological measurement of antibody titres is indicated brospinal fluid (CSF) culture may be indicated. Otitis
in cases of neurological disease associated with infec- media/interna may be associated with sinusitis in rabbits
tious agents. P multocida antibody assays are available and in these cases deep nasal cultures should be obtained
in the UK, but their use is controversial in pet rabbits. from anaesthetised patients. The author uses nasal
Clinicians now question whether this organism is truly endoscopy to obtain samples, but care should be taken
responsible for the many infectious disease conditions it as contaminants commonly occur in the external nares.
is often associated with. However, the assay may be use- Both nares should be sampled for comparison. A pure
ful as a herd health indicator in specific pathogen-free single culture is likely to be significant, while mixed cul-
rabbits in a laboratory situation. tures are likely to represent normal bacterial flora.
E cuniculi antibody assays and measurement of anti-
body titres are also available in the UK. An indirect CEREBROSPINAL FLUID ANALYSIS
ELISA is used to measure serum antibody levels CSF may be collected in small volumes from both the
(immunoglobulin G) to the parasite. Levels rise three to cisterna magna and the lumbosacral epidural space in
four weeks following infection and peak at nine weeks. rabbits. This procedure is indicated in animals with neu-
A single negative result in a healthy animal does not rological conditions associated with the central nervous
therefore rule out recent infection due to this parasite and system. Samples are collected under general anaesthesia
a repeat test four weeks later is recommended to elimi- and the procedure is similar to that described in the cat.
CSF analysis should, where possible, be performed prior
to myelography because injection of contrast material
may exacerbate clinical signs in cases of meningitis.

RADIOGRAPHY
Sedation is necessary for radiography in rabbits and
standard radiographic views are the same as those for

NORMAL CEREBROSPINAL FLUID ANALYSIS IN THE RABBIT

Value Concentration

Total protein <59 mg/dl

Glucose 4·16 mmol/litre
Sodium 149 mmol/litre
Potassium 3 mmol/litre
Anatomical site and positioning of a rabbit (illustrated
on a cadaver specimen) in preparation for a cerebrospinal Red blood cell count 0/µl (except with iatrogenic
tap. Note that, in practice, sterile surgical drapes should contamination)
be used and a stringent aseptic technique is essential. White blood cell count <5/µl
Picture, Michelle Ward

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the cat and dog. However, the author additionally obtains

skull radiographs (lateral, dorsoventral, left and right 45°
oblique and, occasionally, open-mouth views) as a rou-
tine. Orthopaedic abnormalities, such as fractures, luxa-
tions, hip dysplasia, scoliosis of the spine, vertebral
spondylosis and osteoarthritis in older animals, are seen
relatively commonly on radiographs of rabbits.

COMPUTED TOMOGRAPHY
Computed tomography (CT) is an extremely useful diag-
nostic technique for evaluating the brain, vertebral col-
umn and all calcified structures in rabbits. The author
has found the technique, which requires the animal to be
anaesthetised and placed within a rotating x-ray beam,
extremely helpful for the diagnosis of upper and lower
respiratory tract disease, middle ear disease, dental dis-
ease and facial masses in this species. CT often reveals
more extensive soft tissue and bony changes associated
with facial abscesses in the rabbit than are immediately
apparent radiographically.
The use of CT is becoming more widespread, with
many referral centres and universities offering this ser-
vice. It may therefore increasingly become an option for
the veterinary surgeon in practice, particularly if the
animal is insured, since it is a costly procedure.
T1-weighted transverse MRI scan of the skull of a rabbit
taken at the level of the tympanic bullae. The signal void
indicates the air-filled bullae (arrows). The brain is clearly
visible just dorsal to these structures

MAGNETIC RESONANCE IMAGING

As with CT, magnetic resonance imaging (MRI) is also
now more readily available to the veterinary surgeon as
an advanced imaging tool. MRI involves placing the ani-
mal within a magnetic field and then applying a pulsed
radio wave, which results in the emission of radio sig-
nals to produce an image. The technique is useful for
identifying soft tissue abnormalities and enables fine
detail to be visualised. It is particularly helpful in rabbits
with central nervous system disease as it allows soft
tissue masses (eg, granuloma, tumours) and inflammato-
ry or oedematous soft tissue changes to be detected. It is
not useful for imaging bone abnormalities. In animals
CT is now relatively widely available and is a useful imaging that have metal implants, the image may be disrupted
technique for the assessment of neurological disease in pet resulting in a non-diagnostic picture. The technique
rabbits
requires a general anaesthetic.

PRINCIPAL NEUROLOGICAL AND

MUSCULOSKELETAL CONDITIONS
IN RABBITS

HEAD TILT/VESTIBULAR DISEASE

Head tilt/torticollis is a very common clinical presenta-
tion in rabbits and is usually acute in onset. In severe
cases, an animal may lose balance, fall or roll over. The
lesion may be associated with the central or peripheral
nervous systems and it is important to distinguish
between the two sites to narrow down the list of differ-
ential diagnoses. Nystagmus may be seen with both cen-
tral and peripheral disease. In cases of central disease, it
is likely to be horizontal, vertical or rotary, with the fast
phase in any direction and it may vary with changes in
(left) Sagittal CT reconstruction, displayed in a bone window, of the skull of a normal rabbit head position. In animals with peripheral disease, nys-
taken at the level of the incisors. The upper and lower incisor teeth are clearly visible, as are tagmus is usually horizontal or rotary; the fast phase is
the air-filled nasal turbinates. (right) Dorsal CT reconstruction of the same skull taken at the
level of the nasal turbinates. This image clearly shows the bony nasal septum, nasal cavities,
away from the side of the lesion and the direction is not
and nasal turbinates and their associated soft tissue structures altered by changes in head position. Other neurological

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Differential diagnoses for head tilt

Other potential causes of head tilt in rabbits
include herpesvirus, toxoplasmosis, cerebrovascular
accidents, degenerative changes, rabies virus, cere-
brospinal nematodiasis, listeriosis, trauma and neo-
plasia (eg, pituitary adenoma), with clinical signs
depending on the site of the lesion.
Human herpes simplex 1 virus has been reported
in a pet rabbit, causing neurological signs such as cir-
cling secondary to meningoencephalitis. The source
of infection was thought to be from close contact
with a person with herpes labialis (cold sore).
T1-weighted parasagittal MRI scan of the skull of a rabbit Exposure to Toxoplasma gondii is common in
taken at the level of the cheek teeth, which are visible with
domestic rabbits, but infection is often subclinical
their associated soft tissue structures. The brain, air-filled
tympanic bullae and major blood vessels (arrows) are visible and latent. Clinical signs are rare, but may include
(note that air-filled spaces appear black on MRI scans) pyrexia, lethargy, posterior paralysis, head tremor,
ataxia and death, following ingestion of feed
or water contaminated with infected cat faeces.
signs are usually present with central disease. Affected
Serological testing is available and treatment with
rabbits generally adapt to the head tilt and clinical signs
trimethoprim-sulpha drugs and pyrimethamine or
may resolve in time. The two major differential diag-
doxycycline is indicated. Feed containers should be
noses for head tilt in rabbits are bacterial otitis media/
covered as a preventive measure. The disease can
interna (eg, P multocida or Staphylococcus aureus infec-
be transmitted transplacentally in rabbits.
tion) and encephalitozoonosis.

BACTERIAL OTITIS MEDIA/INTERNA

The most common organisms associated with bacterial ANTIBIOTIC TREATMENT OF PASTEURELLOSIS IN RABBITS
otitis media/interna in rabbits are P multocida, Bordetella Antibiotic Dosage and route Notes
bronchiseptica, S aureus, Pseudomonas aeruginosa,
Cefalexin 11-22 mg/kg po every eight hours
Escherichia coli and Proteus mirabilis. Otitis externa
Chloramphenicol 30-50 mg/kg po every 12 hours
may be evident on aural examination following rupture of
Enrofloxacin 5-20 mg/kg po, sc, im or iv every Irritant; muscle necrosis/sterile
the tympanic membrane. Infection may also spread from 12 hours for 14 to 30 days abscess formation possible with
the upper respiratory tract via the Eustachian tubes. sc or im injection
Licensed in pet rabbits
Diagnosis is based on clinical signs, radiography of the
Tetracycline 50-100 mg/kg po every eight to 12 hours
tympanic bullae, microbial culture and sensitivity testing,
Trimethoprim-sulpha 15-30 mg/kg po, sc or im every 12 hours Irritant when given sc – causes
and CT scanning. Treatment comprises long-term sys- tissue necrosis
temic antibiotics sensitive to Pasteurella species (see po Orally, sc Subcutaneously, im Intramuscularly, iv Intravenously
table on the right), but this should be based on culture and
sensitivity testing. Flushing of the affected ear canal with
saline under general anaesthesia and the application of ENCEPHALITOZOONOSIS
topical antibiotic drops (eg, enrofloxacin) or, in severe E cuniculi is an obligate intracellular mammalian proto-
cases, bulla osteotomy may also be indicated. Osteotomy zoal parasite of the phylum Microspora. Infections occur
is associated with a high risk of postoperative complica- primarily in rabbits, but also in rodents, foxes, monkeys,
tions. In severe cases, metoclopramide may be given to cats, dogs, sheep, goats, pigs and humans. Close contact
prevent nausea occurring secondarily to vestibular dam- between owners and susceptible pet species may lead to
age. Prochlorperazine, a phenothiazine derivative, may an increase in human exposure to this parasite.
be useful in rabbits with head tilt as it acts on vestibular Transmission occurs orally following ingestion of
pathways. It is used in humans with vestibular disease contaminated tissues, food items or infected urine. Trans-
and is available as an oral suspension. placental transmission and infection following inhalation
have also been reported. Spores may survive for some
time in the environment in extreme conditions but, at
normal temperatures (22ºC) and in dry conditions, their
survival time is on average four weeks. They are easily
destroyed by boiling, autoclaving and most routine
disinfectants.
Following ingestion, the parasite infects macrophages
and travels via the circulation to the liver, kidneys, cen-
tral nervous system, lungs and heart. The host cell rup-
tures, releasing infective spores, and resulting in chronic
inflammation and granuloma formation. Infected rabbits
may be asymptomatic and may remain carriers. Clinical
signs associated with this disease are listed in the table
on page 216.
Severe, acute-onset head tilt in a young rabbit, which was
A recent study by the author has indicated that the
still able to eat and adapted well to the disability seroprevalence of antibodies to E cuniculi in the domes-

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ENCEPHALITOZOONOSIS IN RABBITS: CLINICAL SIGNS current infection (eg, pasteurellosis) and antibiotic thera-
AND DIFFERENTIAL DIAGNOSES py may also be indicated.
Clinical signs Differential diagnoses
Treatment is aimed at reducing inflammation and
inhibiting spore formation. The success of treatment
Head tilt Otitis media/otitis interna
depends on the chronicity of the disease. Chronic cases
Torticollis Spinal fracture, trauma
Hindlimb paresis Bacterial central nervous system with central nervous system disease have advanced
Paralysis abscess (eg, Pasteurella infection) cellular damage and treatment may be unsuccessful.
Retarded growth Splayleg
Collapse Lead toxicity Certainly, once significant neurological signs have devel-
Tremors Toxoplasmosis oped it is unlikely that these will completely resolve
Convulsions
Urinary incontinence although they rarely worsen. Acute cases with urinary
Renal failure incontinence as the presenting clinical sign may resolve
Cataracts and lens-induced
uveitis
with fenbendazole therapy. The prognosis for oph-
Death thalmic disease is good following lens removal.
Prevention of infection may not be possible given
how widespread this parasite appears to be in pet rabbits.
tic rabbit population in the UK is 52 per cent, using an Animals are likely to have already been exposed to the
indirect ELISA technique (Keeble and Shaw 2006). parasite at the time of purchase. With transplacental
Reaching a definitive diagnosis is problematic transmission and a relatively short-lived maternal anti-
because the organism is difficult to isolate in the live body response, it is unlikely, even with early weaning at
rabbit and may not be isolated even on postmortem four weeks of age, that breeders would be able to elimi-
examination. Classically, histopathology of the kidney or nate this disease from their collection. Establishment of
brain demonstrates granulomatous changes or intracellu- an E cuniculi-free group of rabbits has been described,
lar organisms. Ideally, seropositive animals should be but requires regular testing and removal of positive ani-
monitored with sequential measurement of antibody mals, and is time consuming and expensive. It is there-
titres to determine whether these animals develop clini- fore important to recommend standard control measures,
cal signs of infection and associated rising titres, or such as testing and isolation of positive animals, prophy-
whether they represent asymptomatic carriers or have
been previously exposed and recovered. Seroconversion
precedes renal shedding by four weeks, so antibody
assays could be used in a multi-rabbit household to
screen in-contact animals following a clinical case. A
presumptive diagnosis is made based on a single high
antibody titre associated with clinical signs. It should be
remembered that clinical signs may also be due to con-

TREATMENT OPTIONS FOR ENCEPHALITOZOONOSIS IN RABBITS

Treatment Dose rate Comments

Glucocorticoids Dexamethasone Reduce granulomatous inflammation

0·1-0·2 mg/kg sc every 48 hours Prednisolone may alleviate clinical signs,
for three doses but use with extreme care in rabbits, as it
is immunosuppressive
Central nervous system signs treated with
glucocorticoids may resolve in 50 per cent
of cases

Albendazole 10-15 mg po every 24 hours Use in rabbits is experimental and long-term

for three months side effects are unknown
Evidence suggests it is teratogenic and
embryotoxic in rabbits
Recent anecdotal reports suggest that this
drug may cause pyrexia, pancytopenia and
liver failure in rabbits

Fenbendazole 20 mg/kg po every 24 hours Fenbendazole is reportedly effective in

for 28 days reducing clinical signs in less advanced cases Rabbit with Encephalitozoon cuniculi infection showing
and also in preventing infection in exposed head tilt (above) and urinary scalding secondary to
rabbits incontinence (below)
Diazepam 0·1 mg sc, as necessary Used to control seizures, circling and rolling

Ophthalmic disease

Albendazole 10-15 mg po every 24 hours Phacoclastic uveitis may be treated

for three months medically or, in severe cases, enucleation
may be indicated

Prednisolone Topical 1% prednisolone Lens removal using phacoemulsification

acetate drops every 12 hours has also been described
for eight weeks Corticosteroid treatment may be necessary
postoperatively

Atropine 1% atropine drops every

12 hours

po Orally, sc Subcutaneously

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lactic treatment of in-contact animals, strict hygiene

practices, raised food dishes and the use of water bottles
rather than bowls, in a disease situation. Avoid contact
with wild rabbits and rodents since these could potential-
ly be a source of infection.

PARESIS/PARALYSIS
Posterior paresis or paralysis is a common neurological
presentation in pet rabbits. The main causes include
encephalitozoonosis, lumbar vertebral fracture/luxation,
spondylosis, osteoarthritis, splayleg, ulcerative podo-
Splayleg in a six-week-old
dermatitis, intervertebral disc disease, toxoplasmosis, rabbit. Note the abducted
hypovitaminosis A and neoplasia. hindlimb

Lumbar vertebral fracture or luxation

Incorrect handling may result in spinal luxation or frac- Ulcerative pododermatitis
ture, particularly around the lumbosacral region (L7). Severe ulcerative pododermatitis, usually involving the
The spinal cord in rabbits extends the whole length of plantar metatarsus, is often seen in pet rabbits secondary
the vertebral column, and therefore damage at any level to poor hygiene, or due to abrasive flooring or cages
will affect both upper and lower motor neurons. with wire floors. Obese rabbits, giant breeds and rex rab-
Common additional signs are loss of skin sensation, and bits with thin plantar fur pads are predisposed to the con-
urinary and faecal incontinence. The diagnostic approach dition. Necrotic sores rapidly develop into infected
is the same as that for other species. Absence of deep ulcers with underlying osteomyelitis. Diagnosis is based
pain indicates a poor prognosis, but this test is not reli- on clinical signs, radiography of the affected area, and
able as the rabbit may hide signs of pain. bacterial culture and sensitivity testing. Treatment com-
Treatment in acute cases consists of intravenous prises surgical debridement of necrotic tissue, flushing
shock doses of methylprednisolone. In chronic cases, the area with topical antiseptics, application of topical
supportive care may be instigated, but if the prognosis antibiotic-impregnated dressings, and the administration
for a return to normal function is poor, euthanasia is of systemic antibiotics, non-steroidal anti-inflammatory
indicated. Animals with spinal instability or compression drugs and analgesics. In severe cases with osteomyelitis,
should ideally undergo surgical stabilisation. If the amputation may be necessary. The underlying cause
defect is stable, cage rest for six weeks is indicated. should be addressed.
Affected animals may require intensive nursing, with
manual bladder expression and long-term non-steroidal Intervertebral disc disease
anti-inflammatory drug therapy. The use of carts adapted Intervertebral disc disease is rare in rabbits, but has been
to support the hindlimbs of rabbits has been reported, reported with associated posterior paralysis, and urinary
although the ethics of using these systems in an animal and faecal incontinence.
so prone to stress should be considered.
SEIZURES
Spondylosis and osteoarthritis Causes of seizures in rabbits include encephalitozoono-
Spondylosis and osteoarthritis are increasingly common sis, bacterial encephalitis or meningitis (eg, Pasteurella,
in pet rabbits as longevity improves as a result of better Toxoplasma, Listeria infection), pregnancy toxaemia,
husbandry and diet. Affected animals are often reluctant heatstroke, lead toxicity, hypoxia, azotaemia, electrolyte
to move, adopting a hunched posture or abnormal gait, imbalances, terminal systemic disease (eg, viral haemor-
and they may have concurrent urine scalding of the peri- rhagic disease), neoplasia, toxaemia, cardiovascular dis-
neum. Diagnosis is based on radiography, and treatment ease, hypovitaminosis A and hereditary ataxia (glycogen
comprises long-term analgesia and anti-inflammatory storage disease). Idiopathic epilepsy is reported in blue-
drug administration. Deep bedding material should be eyed white rabbits. Symptomatic relief of seizures with
provided. The perineum should be clipped and bathed, diazepam can be effective in addition to addressing the
barrier creams applied, and antibiosis administered, if underlying cause. If a final diagnosis is not obtained,
indicated. treatment with oral phenobarbitone at 1 to 2 mg/kg/day
and systemic antibiotics may be useful. However, the
Splayleg prognosis is generally poor.
Splayleg is a non-specific term describing a number of
developmental conditions affecting the femur and occur- Lead toxicity
ring in young rabbits from birth up to a few months old. Lead toxicity is common in indoor rabbits housed in old
Animals are unable to adduct one or more limbs. The buildings where ingestion of lead-based paint can occur.
underlying cause is an inherited simple autosomal reces- Clinical signs include weight loss, depression, anorexia,
sive condition and therefore breeding from the same intestinal ileus, anaemia, mild tremors, hindlimb ataxia
parents and affected offspring is not recommended. and seizures. Radiography may show radiodense parti-
Euthanasia should be considered where multiple limbs cles. Haematology reveals nucleated red blood cells,
are involved and the animal is severely affected. In hypochromasia, poikilocytosis and cytoplasmic baso-
milder cases, the animal may be able to cope with the philic stippling. Heteropaenia, lymphocytosis and a
deformity. Environmental factors, such as the type of reduced haematocrit may also be seen. Diagnosis is
bedding and floor structure, have been implicated in the confirmed by the finding of elevated blood lead levels.
pathogenesis of splayleg in young rabbits. Treatment is by chelation with sodium calcium edentate

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been suggested that rabbits may also suffer from myas-

thenia gravis, although this has not been definitively
shown.

LAMENESS/ABNORMAL GAIT
Assessment of gait should be part of any routine clinical
examination. Common causes of lameness in rabbits
include fractures, luxations, traumatic injury/sprains,
osteoarthritis, septic arthritis, splayleg/hip dysplasia,
pododermatitis, spinal disease, neoplasia and osteo-
myelitis (including mycobacterial bone infection).
Spinal disease is common in rabbits, with vertebral
spondylosis, scoliosis, kyphosis and lordosis being easily
diagnosed on radiographic examination. Findings may
be incidental, but associated clinical signs range from
mild gait abnormalities to severe lameness, perineal cae-
cotroph accumulation and urinary scalding. Lesions may
be painful leading to anorexia and intestinal ileus.
Possible predisposing causes include small cage size, sex
of the animal (spinal disease is more common in females
due to high calcium requirements during pregnancy and
Lateral radiograph showing lactation) and lack of exercise. Congenital spinal abnor-
vertebral spondylosis in a malities in pet rabbits include hemivertebrae, which may
rabbit
at a dose of 27·5 mg/kg subcutaneously, twice daily, for be asymptomatic.
five days on, five days off, five days on, followed by
retesting of blood lead levels. Motility modifiers may
also be indicated. If the haematocrit is significantly ETHICAL CONSIDERATIONS
decreased, a blood transfusion may be necessary. AND PROGNOSIS

Tumours It is important from the outset to discuss the prognosis

Tumours of the central nervous system, such as pituitary with the owner of any rabbit presenting with advanced
adenoma and teratoma, can occur in rabbits, with clinical neurological signs. These cases can prove clinically
signs varying depending on the site of the lesion. Diagno- challenging and a definitive diagnosis may not be possi-
sis using MRI is indicated. The prognosis is poor. ble, particularly if there are financial constraints and
advanced diagnostic imaging techniques are not avail-
MUSCLE WEAKNESS able. In patients where quality of life is significantly
Causes of generalised muscle weakness include hypo- compromised, euthanasia should always be considered.
vitaminosis E/selenium deficiency, cerebrovascular acci-
dent, spinal lesions, bacterial infection, toxoplasmosis, Acknowledgement
The CT and MRI scans that appear on
sarcocystis, coccidiosis and metabolic disease (eg, hypo- pages 214 and 215 were provided by
calcaemia, hypokalaemia and hepatic lipidosis). It has the Diagnostic Imaging Unit, Royal (Dick)
School of Veterinary Studies, University
of Edinburgh.

Treatment options for References

KEEBLE, E. J. & SHAW, D. J. (2006)
neuromuscular disease Seroprevalence of antibodies to
Encephalitozoon cuniculi in domestic
When presented with a neurological case, initial rabbits in the United Kingdom. Veterinary
Record (In press)
therapy and patient stabilisation is paramount prior
PARGA, M. L. (2003) Assessment of the
to further diagnostic tests. Animals showing seizure efficacy of meloxicam and development
activity should be treated with either diazepam (0·5 of a pain-scoring system based on
behaviour in rabbits undergoing elective
to 2 mg/kg intravenously or per rectum) or midazo- surgery (Abstract). Proceedings of the
lam (0·07 to 0·22 mg/kg intravenously or intramus- BSAVA Congress. Birmingham, April 3
to 6. p 555
cularly). This regimen can be repeated three times
if seizures are refractory. Affected rabbits may be
Further reading
anorexic and, in these cases, supportive care with FLECKNELL, P. (2000) Manual of Rabbit
fluid therapy, analgesia, gastrointestinal motility Medicine and Surgery. Gloucester, BSAVA
drugs, probiotics, vitamins and the provision of a HARCOURT-BROWN, F. (2002) Textbook
of Rabbit Medicine. Oxford, Butterworth-
high fibre diet is indicated. Prophylactic systemic Heinemann
antibiotic treatment may be instigated pending HARCOURT-BROWN, F. M. & HOLLOWAY,
H. K. R. (2003) Encephalitozoon cuniculi
further diagnostic tests. In cases of head trauma, in pet rabbits. Veterinary Record 152,
oxygen administration, intravenous fluid therapy, 427-431
QUESENBERRY, K. E. & CARPENTER, J. W.
methylprednisolone (30 mg/kg intravenously, if (Eds) (2004) Ferrets, Rabbits and Rodents:
concurrent spinal injury is present), furosemide (0·7 Clinical Medicine and Surgery, 2nd edn.
Missouri, W. B. Saunders
mg/kg intravenously) and mannitol (0·25 to 1 g/kg
SILVERMAN, S. A. & TELL, L. A. (2005)
intravenously) may be indicated. Radiology of Rodents, Rabbits and
Ferrets. Missouri, Elsevier

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Common neurological and musculoskeletal

problems in rabbits
Emma Keeble

In Practice 2006 28: 212-218

doi: 10.1136/inpract.28.4.212

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