Pasteurella (neurological)

Pasteurella multocida is a gram-negative bacterium that commonly inhabits the upper respiratory tract of rabbits and is responsible for a wide range of infections collectively referred to as pasteurellosis. While most rabbit owners are familiar with snuffles, the respiratory form of the disease, Pasteurella can spread beyond the nasal passages to cause severe neurological disease when it invades the central nervous system. Neurological pasteurellosis occurs when bacteria travel from the nasal passages, sinuses, or ears to infect the inner ear structures, meninges surrounding the brain, or the brain tissue itself. This represents one of the most serious manifestations of Pasteurella infection and requires aggressive, prolonged treatment for any chance of recovery.

The development of neurological complications from Pasteurella typically follows a path of least resistance from the upper respiratory tract. The most common route involves spread from chronic middle ear infection through the thin bone separating the middle and inner ear, subsequently affecting the vestibular system and potentially the brain. Alternatively, bacteria may spread through the bloodstream to seed the meninges or brain directly. Some cases involve extension from sinus infections through the cribriform plate into the brain. Understanding this progression helps explain why early and aggressive treatment of respiratory Pasteurella infections is so important for preventing these devastating neurological complications.

The impact of neurological Pasteurella infection on affected rabbits is severe and multifaceted. Vestibular signs including head tilt, loss of balance, circling, and nystagmus dramatically impair the rabbit's ability to function normally. More severe cases involving brain abscesses or meningitis can cause seizures, paralysis, behavioral changes, and death. Even with successful treatment, many rabbits are left with permanent neurological deficits such as a persistent head tilt. The condition's impact extends beyond neurological function, as affected rabbits often stop eating due to disorientation and nausea, putting them at immediate risk for the life-threatening secondary complication of GI stasis. Caregivers face significant challenges in nursing these severely ill patients.

Treatment of neurological pasteurellosis is possible but requires commitment to long-term antibiotic therapy, often lasting months rather than weeks. Early intervention offers the best chance of recovery, but because rabbits instinctively hide signs of illness, infections may be advanced before obvious neurological signs prompt veterinary attention. Working with a rabbit-savvy veterinarian is absolutely essential, as treatment protocols, appropriate antibiotic selection, and supportive care requirements differ significantly from those for cats and dogs. Many antibiotics that are standard treatments for bacterial infections in other species are fatal to rabbits, making veterinary expertise in rabbit medicine critical for safe and effective treatment.

The primary cause of neurological pasteurellosis is infection with Pasteurella multocida, a bacterium that colonizes the nasal passages of a significant percentage of apparently healthy rabbits. Studies suggest that up to 75% or more of domestic rabbits harbor this organism, though most remain asymptomatic carriers. Disease develops when factors such as stress, concurrent illness, immunosuppression, or bacterial virulence tip the balance from colonization to active infection. From established respiratory infection, bacteria can spread to cause otitis media, which subsequently extends to involve the inner ear and vestibular apparatus. Hematogenous spread through the bloodstream can seed bacteria to the meninges, brain, or spinal cord.

Genetic and immune factors influence susceptibility to Pasteurella infection and its progression to neurological disease. Rabbits with robust immune function may harbor the bacteria indefinitely without ever developing disease, while those with compromised immunity are at greater risk for active infection and systemic spread. While no specific genetic mutations causing susceptibility have been identified, there is likely variation in immune competence among individual rabbits and potentially among breeds. Rabbits from breeding programs with histories of Pasteurella problems may carry increased susceptibility, though separating genetic from environmental transmission in such cases is difficult.

Environmental and lifestyle factors play crucial roles in determining whether latent Pasteurella infection progresses to active disease. Stress is perhaps the most significant trigger, as it suppresses immune function and allows bacterial proliferation. Sources of stress include overcrowding, temperature extremes, poor ventilation, dirty living conditions, transportation, introduction of new rabbits, loss of a bonded companion, and inadequate diet. Rabbits housed in environments with poor air quality, ammonia buildup from urine, or dusty bedding have irritated respiratory mucosa that is more susceptible to infection. Concurrent infections with other respiratory pathogens may create conditions favorable for Pasteurella proliferation and spread.

Risk factors for neurological spread specifically include pre-existing chronic ear infections, dental disease with root involvement near the ear structures, untreated or inadequately treated upper respiratory infections, and any condition causing immunosuppression. Rabbits with recurrent respiratory symptoms are at ongoing risk for eventual systemic spread. Those who have received short courses of antibiotics that suppressed but did not eliminate infection may experience apparent resolution followed by recurrence and potentially more severe disease. Senior rabbits and those with chronic illnesses face increased risk due to age-related immune decline and the cumulative effects of long-term Pasteurella colonization.

The mechanism by which Pasteurella causes neurological disease involves bacterial invasion of normally sterile spaces followed by inflammation and tissue damage. In otogenic spread, bacteria traverse from the middle ear through the bony structures to reach the inner ear, causing labyrinthitis and vestibular dysfunction. The close proximity of the inner ear to the brain means infection can extend intracranially. Bacteria reaching the meninges cause meningitis, an inflammation of the brain coverings that is extremely serious. Brain abscesses may form as localized pockets of infection. The resulting inflammation, pressure effects, and direct tissue damage produce the neurological signs observed clinically. Secondary effects including anorexia and dehydration rapidly lead to GI stasis, compounding the rabbit's critical condition.

Early warning signs of neurological Pasteurella infection may include subtle balance problems, slight head tilting that the rabbit seems to self-correct, or changes in coordination that observant owners might notice before dramatic symptoms develop. Many cases, however, are preceded by more obvious signs of respiratory or ear infection such as nasal discharge, sneezing, scratching at ears, or a bad smell from the ear canal. Because Pasteurella often smolders as a chronic low-grade infection before neurological spread, there may be a history of intermittent respiratory symptoms that seemed minor. Any rabbit with known Pasteurella infection should be monitored closely for neurological changes, as early detection and treatment offer the best outcomes.

Common symptoms of neurological pasteurellosis depend on which structures are affected. Vestibular involvement causes the classic presentation of head tilt, where the rabbit holds their head rotated with one ear lower than the other. Nystagmus, an involuntary rhythmic movement of the eyes, typically accompanies vestibular disease. The rabbit may circle toward the affected side, have difficulty walking straight, fall over, or roll uncontrollably during acute episodes. Ataxia, or incoordination, makes normal hopping difficult or impossible. In severe cases, the rabbit cannot maintain normal posture and lies on their side. When the brain itself is affected, additional signs may include seizures, altered mental status, blindness, and behavioral changes.

Behavioral changes accompanying neurological Pasteurella infection are significant and reflect both the direct effects of nervous system disease and the rabbit's response to feeling unwell. Affected rabbits typically show dramatic decreases in activity, often lying still to minimize the disorientation caused by vestibular dysfunction. Appetite usually drops significantly, as nausea from vestibular disease and general malaise reduce interest in food. This decreased eating is extremely dangerous in rabbits, as GI stasis can develop within hours and becomes life-threatening within 24 to 48 hours. The rabbit may appear depressed, withdrawn, or unresponsive. Grooming usually stops, leading to an unkempt coat. Some rabbits become irritable or bite when handled, particularly if movement worsens their symptoms.

Physical signs visible on examination include the obvious head tilt and any nasal or ocular discharge indicative of concurrent respiratory disease. Looking into the ears may reveal discharge, debris, or ruptured eardrums, though the middle and inner ear where infection typically resides cannot be visualized without special equipment. Palpation may reveal pain in the ear or jaw area. Neurological examination findings include nystagmus, positional strabismus where the eyes are misaligned depending on head position, absent or decreased responses on the affected side, and abnormal reflexes if the brain or spinal cord is involved. Weight loss often accompanies illness that has been developing over time. Dehydration may be present if the rabbit has stopped drinking.

Symptom progression in neurological pasteurellosis can be rapid or gradual depending on the severity and location of infection. Some rabbits develop dramatic vestibular signs seemingly overnight, while others show gradual worsening over days to weeks. Without treatment, signs typically progress and additional deficits may develop as infection spreads. The acute phase, with severe rolling, nausea, and disorientation, is most intense in the first few days to weeks. Some rabbits show improvement over time as they compensate for vestibular damage, while others remain severely affected. Brain involvement generally carries a worse prognosis than isolated vestibular disease.

Emergency symptoms requiring immediate veterinary attention include sudden severe head tilt with rolling or inability to stand, seizures, complete inability to eat or drink, signs of shock such as weakness and cold extremities, high fever, or rapid deterioration. Any rabbit that has not eaten for 12 or more hours is experiencing an emergency, and neurologically compromised rabbits are at particularly high risk for GI stasis. Open-mouth breathing, though rare, would indicate a dire emergency. Neurological signs developing in a rabbit with known respiratory Pasteurella infection should prompt urgent care, as this indicates spread beyond the respiratory tract. Progressive worsening despite treatment requires reassessment and potential treatment modification.

Initial examination of a rabbit with suspected neurological pasteurellosis begins with a comprehensive history and physical assessment by a rabbit-savvy veterinarian. The vet will inquire about any history of respiratory symptoms, ear problems, or previous Pasteurella diagnosis. A thorough physical examination includes evaluation of the respiratory tract for nasal discharge, the ears for visible abnormalities or pain, and the teeth for dental disease that might contribute to ear or sinus problems. The neurological examination specifically assesses the type and severity of deficits, helping localize the problem to vestibular structures, brain, or both. Finding an experienced rabbit veterinarian is crucial, as the examination techniques and interpretation differ from those used in dogs and cats.

Diagnostic testing helps confirm Pasteurella involvement and assess the extent of disease. Skull radiographs can reveal changes in the tympanic bullae consistent with middle ear disease, though significant bony changes must accumulate before they become visible on X-rays. CT scanning provides far superior visualization of the ear structures, sinuses, and brain and is recommended when available. Culture and sensitivity testing of any ear discharge helps confirm Pasteurella involvement and guide antibiotic selection. Blood work including complete blood count and chemistry panel assesses overall health and may show changes consistent with infection. Testing for Encephalitozoon cuniculi through serology is often recommended since this parasite causes similar vestibular signs and frequently coexists with Pasteurella infection.

Advanced diagnostics may be warranted in complex cases or when initial treatment fails. MRI provides the best visualization of soft tissue structures including the brain and can identify abscesses, meningitis, or other intracranial pathology not visible on CT. However, MRI availability is limited and costs are substantial. Cerebrospinal fluid analysis obtained via spinal tap can confirm meningitis and may yield bacteria on culture, though this invasive procedure carries risks and requires anesthesia. Specialized bacterial PCR testing may detect Pasteurella DNA in samples when culture is negative. These advanced tests are typically reserved for cases not responding to empirical treatment or when determining prognosis for decision-making.

Differential diagnosis for vestibular signs in rabbits includes several conditions that may appear similar to neurological pasteurellosis. Encephalitozoon cuniculi is a common cause of head tilt and vestibular dysfunction and may occur alone or concurrently with Pasteurella. Other bacterial infections besides Pasteurella can cause similar symptoms. Trauma to the head or ear can cause vestibular damage. Rarely, tumors affecting the ear or brain cause vestibular signs. Stroke, while uncommon in rabbits, is a consideration. Ear mites causing severe irritation and secondary infection may contribute to ear disease. The veterinarian uses history, examination findings, and diagnostic test results to differentiate among these possibilities, though empirical treatment covering multiple likely causes is often initiated given the urgency of the situation.

Emergency and immediate treatment of neurological pasteurellosis focuses on stabilizing the rabbit while initiating antibiotic therapy. Severely affected rabbits may need hospitalization for intensive supportive care. Anti-nausea medications such as metoclopramide help manage the vertigo-associated nausea that prevents eating. Pain management with meloxicam or other rabbit-safe analgesics addresses discomfort. Fluid therapy corrects dehydration and supports organ function. Because affected rabbits often cannot or will not eat, syringe feeding with critical care formula must begin immediately to prevent GI stasis. The rabbit should be kept in a quiet, dim environment on soft bedding with padding around them to prevent injury during rolling episodes.

Antibiotic therapy is the cornerstone of treatment and must be selected carefully because many antibiotics are fatal to rabbits. Safe and effective options for Pasteurella include enrofloxacin, which is often a first-line choice for respiratory and systemic Pasteurella infections. Trimethoprim-sulfa is another good option that achieves therapeutic levels in the central nervous system. Chloramphenicol penetrates well into the brain and is effective against Pasteurella but requires careful handling due to human health risks. Azithromycin may be used in some cases. Penicillin G by injection rather than oral penicillin may be recommended for severe infections. Combination antibiotic therapy is sometimes employed for serious neurological involvement. It is absolutely critical to avoid oral penicillins, amoxicillin, ampicillin, clindamycin, lincomycin, and erythromycin, as these antibiotics given orally are fatal to rabbits by destroying beneficial gut bacteria.

Long-term antibiotic therapy is essential for neurological Pasteurella because short courses that might clear respiratory infection are insufficient to eliminate bacteria from protected sites like the middle ear, bone, and brain. Treatment typically continues for a minimum of four to eight weeks and may extend to several months depending on response. Some cases require indefinite suppressive therapy to prevent recurrence. Premature discontinuation of antibiotics is a common cause of treatment failure and recurrence. Owners must be prepared for this extended commitment, including the financial costs of prolonged medication. Follow-up cultures, when possible, help guide decisions about antibiotic duration.

Supportive care plays an equally important role alongside antibiotic therapy. Nutritional support through syringe feeding continues until the rabbit is eating adequate amounts independently, which may take days to weeks in severely affected animals. Gut motility agents such as metoclopramide or cisapride support GI function. Subcutaneous fluids may be needed to maintain hydration if the rabbit is not drinking well. Physical support includes keeping the rabbit on soft, padded surfaces to prevent injury and providing rolled towels to help maintain position if they cannot hold themselves upright. Gentle physical therapy once the acute phase resolves can help with compensation and recovery.

Additional medications may be beneficial in managing neurological pasteurellosis. Anti-inflammatory drugs help reduce inflammation in the vestibular apparatus and nervous tissue. Meclizine, an antihistamine used for motion sickness in humans, may help manage vestibular-associated nausea and vertigo in rabbits, though evidence is largely anecdotal. If E. cuniculi coinfection is suspected or confirmed, concurrent treatment with fenbendazole is indicated. Probiotics may help maintain gut health during prolonged antibiotic therapy. Some practitioners recommend immune-supporting supplements, though evidence for efficacy is limited.

Treatment decisions should weigh multiple factors including disease severity, likelihood of meaningful recovery, quality of life during treatment, owner ability to provide intensive nursing care, and financial considerations. Neurological pasteurellosis treatment is time-intensive and costly, requiring weeks to months of medications, frequent veterinary visits, and dedicated nursing care. Some rabbits respond well and recover nearly completely, while others retain significant permanent deficits or fail to improve despite aggressive treatment. Honest prognostic discussions with your veterinarian help set realistic expectations. For severely affected rabbits with poor prognosis or those suffering despite treatment, humane euthanasia may be the most compassionate choice. This difficult decision should be made in partnership with a trusted rabbit-savvy veterinarian.

Recovery timeline for neurological pasteurellosis varies considerably depending on the severity and extent of infection. Some rabbits with relatively mild vestibular involvement show significant improvement within the first week or two of treatment, while those with brain abscesses or meningitis face much longer recovery periods. The acute vestibular signs such as rolling and severe disorientation typically improve faster than full recovery of balance and coordination. Many rabbits continue to improve gradually over weeks to months as they learn to compensate for any permanent vestibular damage. Complete resolution of all symptoms occurs in some cases, while others retain lasting deficits despite successful elimination of infection.

Post-treatment care requires vigilance and consistency throughout the extended treatment period and beyond. Antibiotic administration must be maintained on schedule for the full prescribed duration, even when the rabbit appears to have recovered. Missing doses or stopping early risks relapse with potentially more resistant bacteria. Monitoring appetite and fecal output remains critical throughout recovery, as any decline should prompt immediate attention to prevent GI stasis. Follow-up veterinary appointments allow assessment of progress and adjustment of the treatment plan as needed. Once antibiotics are finally discontinued, close monitoring continues for any signs of recurrence.

Prognosis factors for neurological pasteurellosis include the severity and location of infection, how quickly treatment was initiated, the presence of structural damage such as bone involvement or abscess formation, and the individual rabbit's response to treatment. Rabbits treated early in the course of neurological spread generally fare better than those with established brain involvement. The ability to maintain adequate nutrition during the illness positively affects outcomes. Younger, otherwise healthy rabbits may recover more completely than seniors or those with concurrent health issues. Improvement during the first few weeks of treatment is a positive prognostic indicator, while continued deterioration suggests treatment may not be effective.

Long-term outlook for survivors of neurological pasteurellosis depends on the extent of permanent damage to the vestibular system or brain. Many rabbits retain a permanent head tilt of varying degrees, ranging from barely noticeable to severe. Most rabbits with residual head tilt adapt remarkably well and maintain good quality of life. Balance and coordination may remain somewhat impaired, requiring environmental modifications to prevent injury. Recurrence is possible, particularly if antibiotic therapy was insufficient to eliminate all bacteria, so ongoing vigilance for returning symptoms is important. Some rabbits require periodic courses of antibiotics to manage reactivating infection. Regular veterinary monitoring helps catch any recurrence early.

Primary prevention of neurological pasteurellosis centers on preventing or effectively treating respiratory Pasteurella infection before it can spread. Because Pasteurella is so prevalent in rabbit populations, complete avoidance may be impossible, but minimizing exposure and maintaining strong immune function reduces disease risk. New rabbits should ideally come from sources with low Pasteurella prevalence and should be quarantined before introduction to established rabbits. Any rabbit showing respiratory symptoms such as nasal discharge or sneezing should receive prompt veterinary evaluation and treatment. Complete elimination of respiratory Pasteurella is difficult, but early aggressive treatment may prevent progression to neurological disease.

Environmental prevention focuses on reducing stressors and optimizing conditions to support immune function. Proper ventilation prevents ammonia buildup and reduces respiratory irritation. Temperature should be maintained within comfortable ranges, avoiding extremes that stress rabbits. Clean housing with appropriate bedding changed regularly prevents accumulation of pathogens. Avoiding overcrowding gives each rabbit adequate space and reduces transmission opportunities. A quiet, secure environment minimizes chronic stress. These management factors do not guarantee prevention but significantly reduce the likelihood of latent infections becoming active disease.

Dietary prevention supports overall health and immune function. Unlimited grass hay should form the foundation of the diet, providing essential fiber for GI health and overall wellbeing. Appropriate amounts of fresh leafy greens provide vitamins and antioxidants that support immune function. Quality pellets in appropriate quantities ensure balanced nutrition. Clean, fresh water should always be available. Avoiding sugary treats and high-carbohydrate foods helps maintain optimal health. A healthy rabbit with strong immune function is better equipped to keep Pasteurella colonization from progressing to active disease.

Health maintenance through regular veterinary care enables early detection and treatment of Pasteurella before neurological spread. Annual or biannual wellness exams with a rabbit-savvy veterinarian should include careful assessment of the respiratory tract and ears. Any respiratory symptoms between visits warrant prompt evaluation. Dental care is important because dental disease can contribute to sinus and ear problems that provide routes for Pasteurella spread. Spaying and neutering may indirectly reduce disease risk by eliminating hormonal stressors and reducing territorial behaviors that cause stress. Maintaining a healthy weight and activity level supports overall immune function.

Early intervention when respiratory symptoms appear is the single most effective way to prevent neurological pasteurellosis. At the first sign of nasal discharge, sneezing, or ear problems, seek veterinary care rather than waiting to see if symptoms resolve. If Pasteurella is diagnosed, commit to completing the full prescribed course of antibiotics even when symptoms improve. Discuss with your veterinarian whether extended or preventive antibiotic therapy is warranted for rabbits with recurrent respiratory issues. Learn to recognize early signs of neurological involvement such as subtle balance changes or head positioning so that treatment can begin immediately if spread occurs.

Daily management of a rabbit recovering from or living with neurological pasteurellosis requires consistent routines and close monitoring. Medication administration must be reliable and on schedule, particularly for antibiotics where consistent blood levels are important for efficacy. Many owners find setting phone alarms or using pill organizers helpful for maintaining schedules. Syringe feeding may be necessary during active illness and recovery; technique should be demonstrated by your veterinarian to ensure safe, effective delivery. Monitor food and water intake daily, weighing food bowls if needed to quantify consumption. Check litter box output daily, watching for normal quantity and quality of fecal pellets. Any decline in eating or fecal output warrants immediate attention.

Home environment modifications help keep rabbits with vestibular deficits safe and comfortable. Remove hazards that could cause injury during balance problems, including ramps, multi-level housing, and slippery surfaces. Provide excellent traction on flooring with materials like fleece over rubber mats. Padding around the enclosure edges protects during any wobbling or falling episodes. Food, water, hay, and litter should be easily accessible without requiring climbing or reaching. For rabbits with severe persistent deficits, everything may need to be at ground level with low-sided containers. Ensure the environment is quiet and calm, as stress and startle can worsen symptoms.

Quality of life for rabbits with vestibular disease can remain good despite permanent deficits. Most rabbits adapt remarkably well to head tilts and balance impairments, learning to compensate over weeks to months. Signs of good quality of life include eating with good appetite, normal fecal output, engagement with environment and companions, comfortable resting, and absence of signs of pain or distress. Rabbits with stable residual deficits can enjoy their favorite activities, treats, and social interactions. However, ongoing disorientation, inability to eat unassisted, persistent nausea, or obvious distress indicate poor quality of life that needs to be addressed through treatment adjustment or, if improvement is not possible, humane euthanasia.

Monitoring and ongoing care involves regular assessment for both recurrence of infection and adaptation to any permanent deficits. Watch for worsening head tilt, new neurological signs, or return of acute vestibular episodes that might indicate relapse. Weight should be tracked regularly as a sensitive indicator of overall health. Note any changes in behavior, activity level, or social interactions. Regular veterinary rechecks, typically monthly during active treatment and every few months after stabilization, allow professional assessment and adjustment of care plans. Keep records of symptoms, medications, and any observations to share with your veterinarian.

Caregiver support is important because managing a rabbit with chronic neurological disease is demanding and emotionally challenging. Connect with online communities of rabbit owners facing similar challenges through resources like the House Rabbit Society for practical advice and emotional support. Be realistic about the time and financial commitments involved; neurological pasteurellosis requires months of treatment and potentially ongoing management. Ask for help from family members or friends when needed. Acknowledge the stress of caring for a chronically ill pet and take steps to manage your own wellbeing. Working with a supportive veterinary team who understands both your rabbit's needs and your challenges makes a significant difference in navigating this difficult journey.

Pasteurella infection can affect rabbits of any breed, and no breed has specific immunity or heightened susceptibility to neurological spread of the bacteria. The prevalence of Pasteurella carriers is high across all breeds and types of domestic rabbits. However, certain breed characteristics may influence disease expression or complicate management. Lop-eared breeds have ear anatomy that may predispose them to ear infections and potentially increase risk of otogenic spread to the vestibular system, though direct evidence for increased neurological pasteurellosis in lops is limited. Breeds with shortened faces such as Netherland Dwarfs and similar dwarf breeds may have altered sinus and dental anatomy that affects respiratory pathogen clearance.

Risk factors related to breed type are less significant than individual and environmental factors for neurological pasteurellosis. Rabbits from sources with endemic Pasteurella, such as poorly managed breeding operations or crowded shelters, face higher exposure regardless of breed. Stressed rabbits of any breed are more likely to develop active disease from latent carriers. Senior rabbits across all breeds have age-related immune decline that increases susceptibility. Rabbits with concurrent health conditions such as dental disease, which is more common in certain breeds like lops and dwarfs, may have increased routes for bacterial spread.

Screening recommendations apply broadly rather than to specific breeds. All rabbits should be monitored for signs of respiratory disease, and any symptoms should prompt veterinary evaluation. Serological testing for Pasteurella antibodies exists but has limited utility since many healthy carriers are seropositive. Pre-purchase examination and history review may identify rabbits from high-prevalence sources. For breeding programs, selecting against individuals with chronic respiratory issues may reduce propagation of both the bacteria and any genetic susceptibility to disease. Rescue rabbits often have unknown histories and may have been exposed in shelter environments, warranting close monitoring after adoption.

Commonly co-occurring conditions with neurological pasteurellosis reflect both shared causes and complications of the disease process. Respiratory pasteurellosis, or snuffles, frequently precedes neurological involvement and may continue concurrently, with nasal discharge and sneezing alongside vestibular signs. Otitis media, middle ear infection, is often the intermediate step between respiratory infection and neurological spread. GI stasis develops as a dangerous secondary complication when affected rabbits stop eating due to nausea, disorientation, and malaise; this complication is life-threatening and must be prevented through aggressive nutritional support. Encephalitozoon cuniculi infection causes similar vestibular signs and commonly coexists with Pasteurella, so treatment often addresses both pathogens empirically.

Conditions with similar symptoms to neurological pasteurellosis require differentiation for optimal treatment. E. cuniculi is the primary differential for vestibular disease in rabbits; serological testing, clinical presentation, and response to treatment help distinguish the two, though concurrent infection is common. Inner ear disease from causes other than Pasteurella, including other bacteria or trauma, causes identical vestibular signs. Stroke, while rare in rabbits, can cause sudden vestibular dysfunction. Brain tumors occasionally present with vestibular or other neurological signs. Toxin exposure might cause neurological symptoms. The veterinarian considers these possibilities during the diagnostic workup and may treat empirically while awaiting test results.

Potential complications of neurological pasteurellosis extend beyond the primary nervous system disease. Hepatic lipidosis develops rapidly in rabbits that do not eat adequately and is life-threatening. Aspiration pneumonia can occur if rabbits with vestibular disease inhale food or water during disoriented eating or drinking attempts. Weight loss and muscle wasting occur during prolonged illness. Skin breakdown may develop in rabbits that cannot maintain normal positions or grooming. Eye trauma can occur from rolling episodes or the down eye in rabbits with severe head tilt being pressed against bedding. Corneal ulcers may develop if the eye on the tilted side is not adequately protected. Preventing these complications requires proactive nursing care and prompt attention to any developing problems.