A tetraplegic geriatric dog with horizontal nystagmus presented for acupuncture and rehabilitation evaluation after 2 weeks of unsuccessful treatment with antibiotics and steroids. Magnetic resonance imaging (MRI) of the cerebrum and cerebellum supported the diagnosis of thalamic infarction with no evidence of malignancy. The initial 2-week unsuccessful medical therapy was followed by a combination of acupuncture (dry needle and electro-acupuncture), joint manipulation (compression and traction), and therapeutic exercises. Acupuncture point selection was based on the traditional Chinese veterinary medicine (TCVM) pattern diagnosis of Kidney Qi Deficiency and Blood Deficiency with Wind invasion. After 3 weeks of treatment, the patient was ambulatory with resolution of the nystagmus. This brief communication highlights the synergistic effect of acupuncture and rehabilitation for severely debilitated geriatric patients.