https://idwiki.org/index.php?action=history&feed=atom&title=HINTS_examHINTS exam - Revision history2026-04-07T19:48:16ZRevision history for this page on the wikiMediaWiki 1.43.6https://idwiki.org/index.php?title=HINTS_exam&diff=4257&oldid=prevMaintenance script: Imported from text file2020-07-04T01:17:38Z<p>Imported from text file</p>
<p><b>New page</b></p><div>== Definition ==<br />
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* A three-part physical exam test to rule out posterior/cerebellar stroke in patients presenting with acute vertigo, distinguishing peripheral (acute vestibular syndrome, i.e. labyrinthitis and vestibular neuritis) from central (stroke) pathology<br />
** Head impulse: tests vestibulo-ocular reflex (VOR)<br />
** Nystagmus<br />
** Test-of-Skew deviation: most commonly affected in brainstem strokes<br />
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== Technique ==<br />
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* Preparation: patient seated across from examiner<br />
* Examination<br />
** Head impulse, where the head is held by the examiner and rotated suddenly and sharply in one direction (patient's eyes should remain focussed on examiner's nose)<br />
*** Peripheral: VOR may be impaired<br />
*** Central: VOR usually preserved<br />
** Nystagmus<br />
*** Peripheral: horizontal unidirectional nystagmus, increasing in intensity when the patient looks in the direction of the nystagmus fast phase<br />
*** Central: may present as above, but also can present as bidirectional horizontal, or vertical or torsional nystagmus<br />
** Skew deviation, using the cover-uncover test to<br />
*** Peripheral: normal cover-uncover test<br />
*** Central: abnormal test<br />
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== Interpretation ==<br />
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* If any of the three tests is not consistent with peripheral lesion (impaired head impulse, horizontal unidirectional nystagmus, and no skew deviation), then further investigations for cerebellar disease is warranted<br />
* Mnemonic for danger signs is INFARCT (Impulse Normal, Fast-phase Alternating, Refixation on Cover Test)<br />
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== Further Reading ==<br />
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* Kattah JC, ''et al''.[https://doi.org/10.1161/STROKEAHA.109.551234 HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging]. ''Stroke''. 2009;40(11):3504-10.<br />
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[[Category:Clinical exam]]<br />
[[Category:Neurology]]<br />
[[Category:Strokes]]</div>Maintenance script