Just a review of the HINTS exam:
HINTS Exam: use for pts with ongoing hours/days of vertigo and nystagmus to assess for cerebellar vs peripheral cause; has 3 components
- unilateral, fatigable- likely peripheral
- bilateral, vertical, non fatigable-worrisome!
Test of Skew
- no skew- normal
- skew (eyes dart when uncovered)- worrisome!
Head Impulse test
- no vertigo: normal (eyes stay fixed)
: abnormal (eyes correct back to midline) - vestibular neuritis peripheral
: normal (eyes stay fixed) - cerebellar stroke! worrisome!
Any worrisome findings warrant workup for cerebellar stroke.
Best video explanation I've seen so far: