Key-Gaskell Syndrome (Feline Dysautonomia)

What is Key-Gaskell syndrome?

Also called feline dilated pupil syndrome or feline dysautonomia, Key-Gaskell syndrome is a rare condition of the sympathetic and parasympathetic nervous systems which work in harmony to prepare the body for fight or flight (sympathetic) or relax the body (parasympathetic). This system is responsible for functions in the body that the cat does not consciously control such as respiration, digestion, heartbeat, hormone secretion and pupil dilation/constriction, collectively called the autonomic nervous system (ANS).

First discovered in 1982 by Key and Gaskell in England, Key-Gaskell syndrome is non-inflammatory destruction of the autonomic ganglia. Outbreaks have occurred in the United States, continental Europe, Dubai, and New Zealand. It affects horses (grass sickness), dogs, hares and rabbits.

There is no age, gender or breed predilection.


The cause of Key-Gaskell syndrome is poorly understood; several possible causes have been postulated, which include:

  • Genetic susceptibility
  • Environmental (geographical clusters have occurred)
  • Autoimmune
  • Clostridium botulinum toxin


Gastrointestinal symptoms develop due to intestinal ileus, which is an inability of the intestines to contract normally and move waste out of the body.


Your veterinarian will perform a complete physical examination of the cat and obtain a medical history from you including the onset of symptoms, underlying medical issues, any medication (prescribed or non-prescribed) that the cat is taking.

Diagnostic workup:

Baseline tests: Complete blood count, biochemical profile and urinalysis are usually normal.

Dilute pilocarpine drops: Administration will induce a rapid constriction (shrinking) of the pupil due to loss of nerve control of the iris, and retraction of the third eyelid.

Schirmer’s test: This test measures the level of tear production. A commercial filter strip is placed under the lower eyelid for 60 seconds. The moisture from the eye will slowly descend the strip and the level of moisture measured in mm.

Intradermal histamine injection: This test can check the capillary function. Affected cats will show no response to histamine, compared to a normal cat who will develop a welt on the skin.

Xrays: Diagnostic imaging will reveal megaesophagus (enlarged esophagus), dilated stomach, distended intestinal loops with no signs of peristalsis (wave-like muscle contractions).

Biopsy and histopathology: A sample of the autonomic ganglia is taken by biopsy and sent to a diagnostic laboratory for evaluation.


There is no cure for Key-Gaskell syndrome; the goal of treatment is to manage symptoms, which may include the following:

Elevated feeding position: Feed the cat in an elevated position so that gravity can help to push food down the esophagus. The cat should remain in that position for 10-15 minutes after each meal.

Feeding tube: It may be necessary to place a feeding tube in cats who can are not be fed in an upright feeding position or who are refusing food.

Fluid therapy: To treat cats with dehydration.

Artificial tears: To moisten and lubricate the eyes.

Manually empty the bladder: For cats who are unable to urinate on their own, it will be necessary for the caregiver to express the bladder several times a day.

Medications: Prokinetic drugs could be considered, such as metoclopramide or cisapride to enhance gastric motility. Cholinergic drugs such as bethanechol may be of help in cats with urinary retention.


Unfortunately, the prognosis for cats with Key-Gaskell syndrome is poor.

Julia Wilson is a cat expert with over 20 years of experience writing about a wide range of cat topics, with a special interest in cat health, welfare and preventative care. Julia lives in Sydney with her family, four cats and two dogs. She enjoys photography, gardening and running in her spare time. Full author bio Contact Julia