Demonstration of HINTS examination in a normal subject

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Identifier HINTS_demonstration
Title Demonstration of HINTS examination in a normal subject
Creator Daniel R. Gold, DO, Departments of Neurology, Ophthalmology, Neurosurgery, Otolaryngology - Head & Neck Surgery, Emergency Medicine, and Medicine, The Johns Hopkins School of Medicine; Roksolana Tourkevich, MD, Department of Neurology, The Johns Hopkins School of Medicine
Description In the acute vestibular syndrome - consisting of acute prolonged vertigo, spontaneous nystagmus, imbalance, nausea/vomiting, head motion intolerance which is typically due to vestibular neuritis or posterior fossa stroke - a 3 step test of ocular motor and vestibular function known as HINTS, has higher sensitivity to detect an acute stroke (<72 hours) as compared with MRI diffusion weighted imaging in the hands of a vestibular/eye movement subspecialist. HINTS stands for Head Impulse, Nystagmus, Test of Skew, and with a peripheral lesion (for example on the right), there should be a + head impulse test (HIT) to the right, left-beating unidirectional nystagmus (increasing in left gaze in accordance with Alexander's law), and no vertical refixation saccade with alternating cover testing (i.e., no skew deviation). A central etiology should be strongly suspected when HIT is negative AND/OR nystagmus is direction changing (gaze-evoked) AND/OR a skew deviation is present - i.e., if a "central" pattern is seen in any of the individual 3 tests, the etiology is central until proven otherwise. A labyrinthine stroke could theoretically fulfill all "peripheral" criteria, so adding a finger rub test of hearing at the bedside further increasing the test's sensitivity (with labyrinthine infarct, hearing loss is usually present), and this is known as HINTS "plus." Here the HINTS testing is performed on a normal asymptomatic volunteer. Please refer to: Newman-Toker DE, et al. HINTS outperforms ABCD2 to screen for stroke in acute continuous vertigo and dizziness. Acad Emerg Med. 2013 Oct;20(10):986-96.
Subject Acute Vestibular; Normal VOR; Vertigo; HINTS examination
Publisher Spencer S. Eccles Health Sciences Library, University of Utah
Date 2017
Type Image/MovingImage
Format video/mp4
Relation is Part of NOVEL: Neuro-ophthalmology Virtual Education Library Examination Collection
Rights Management Copyright 2017. For further information regarding the rights to this collection, please visit:
Holding Institution Spencer S. Eccles Health Sciences Library, University of Utah, 10 N 1900 E, SLC, UT 84112-5890
Collection Neuro-ophthalmology Virtual Education Library: NOVEL
Language eng
ARK ark:/87278/s6zs6jsb
Setname ehsl_novel_gold
ID 1209722
Reference URL