Merck Manual

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Pet Owner Version

Dysautonomia in Cats


Caroline N. Hahn

, DVM, PhD, DECEIM, DECVN, Royal (Dick) School of Veterinary Studies, University of Edinburgh

Reviewed/Revised Aug 2018 | Modified Oct 2022

Feline dysautonomia (also known as Key-Gaskell syndrome) is a disorder of the autonomic nervous system, which controls many reflexes and other involuntary neurologic functions. All breeds and age groups are susceptible, although the disease may be more common in younger cats. Feline dysautonomia was first reported in 1982 and initially became widespread in the UK; the incidence declined considerably but recently seems to have risen again. Cases have been reported throughout Europe, a few have been documented in North America, and sporadic cases have been seen in Dubai, New Zealand, and Venezuela. The cause is unknown.

Signs range widely in severity and can develop rapidly or be slowly progressive. Initial signs include mental dullness, loss of appetite, upper respiratory signs, or diarrhea. Additional signs include dilated and unresponsive pupils, drooping or protruding eyelids, difficulty swallowing, dilated esophagus, vomiting, constipation, decreased tear production, and dehydration. The heart rate may slow down, and the cat may develop urinary or fecal incontinence.

Contrast x-rays (a specialized test using a dye that shows up on x-rays) and fluoroscopy (real-time, moving x-rays) can identify a dilated esophagus, and tear tests can show decreased tear production. However, definitive diagnosis requires a tissue sample. Feline leukemia virus infection can also cause some of the signs, but cats with dysautonomia typically test negative for feline leukemia virus.

The main aim of therapy is first to rehydrate the cat and then to maintain adequate fluid balance. Dietary needs must be addressed with IV nutrition or feeding tubes. Supportive care includes keeping the cat warm, emptying the bladder, supporting respiratory function, administering eye drops, and assisting with grooming. A laxative may be needed for constipation. Other medications may be necessary to improve digestion and control of the autonomic nervous system. A small number of cats have recovered, and others are able to survive with lingering signs. However, such improvements often take up to a year. In general, the outlook is poor for severely affected cats.

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