ToolsCalculators
HINTS exam for acute vestibular syndrome
Bedside oculomotor exam to separate central from peripheral vertigo.
HINTS exam for acute vestibular syndrome
Head impulse test
Only interpretable with continuous nystagmus present.
Nystagmus
Test of skew (alternate cover)
ResultPeripheral pattern
Abnormal head impulse, unidirectional nystagmus, and absent skew together favour a peripheral (vestibular) cause.
When to use
- Continuous vertigo, nystagmus, and nausea (acute vestibular syndrome) where central stroke must be excluded.
Formula
Central if ANY of: normal/negative head impulse, direction-changing nystagmus, or present skew deviation. All three benign features are required to call the pattern peripheral.
Pearls and pitfalls
- Valid only in acute vestibular syndrome with persistent nystagmus - not in episodic or positional vertigo.
- A benign HINTS exam outperforms early MRI for excluding stroke, but should be done by an experienced examiner.