Template:HINTS Exam Procedure - Revision history

Patricklin at 17:03, 8 October 2023

2023-10-08T17:03:46Z

← Older revision		Revision as of 17:03, 8 October 2023
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	\| Test of Skew\|\|No skew deviation		\| Test of Skew\|\|No skew deviation
	\|}		\|}

			*Always use correct terminology; "HINTS negative" does not convey a clear interpretation. State "HINTS central" or "HINTS peripheral" as suggested in literature
			**If able, specify the exact exam finding as shown by chart above

	====Head Impulse Test====		====Head Impulse Test====

Patricklin at 16:54, 8 October 2023

2023-10-08T16:54:48Z

← Older revision		Revision as of 16:54, 8 October 2023
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	====Inclusion Criteria====		====Inclusion Criteria====
	*HINTS exam should only be used in patient with acute persistent vertigo, nystagmus, and a normal neurological exam.		*HINTS exam should only be used in patient with acute persistent vertigo, nystagmus, and a normal neurological exam.
			*HINTS exam, when done correctly, has high sensitivity and specificity in distinguishing peripheral vs central etiologies of vertigo
			*Note that the original study was done by neuro-ophthalmologists in a differentiated patient base. This exam has not been studied in a large ED population yet

	====The 3 components of the HINTS exam include:====		====The 3 components of the HINTS exam include:====
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	''Test of vestibulo-ocular reflex function''		''Test of vestibulo-ocular reflex function''
	#Have patient fix their eyes on your nose		#Have patient fix their eyes on your nose
	#Move their head in the horizontal plane to the left and right		#Move their head rapidly in the horizontal plane to the left and right
	#*When the head is turned towards the normal side, the vestibular ocular reflex remains intact and eyes continue to fixate on the visual target		#*When the head is turned towards the normal side, the vestibular ocular reflex remains intact and eyes continue to fixate on the visual target
	#*When the head is turned towards the affected side, the vestibular ocular reflex fails and the eyes make a corrective saccade to re-fixate on the visual target <ref>Barraclough K, Bronstein A. Vertigo. BMJ. 2009;339:b3493</ref><ref>Kuo CH, Pang L, Chang R. Vertigo - part 1 - assessment in general practice. Aust Fam Physician. 2008;37(5):341-7</ref>		#*When the head is turned towards the affected side, the vestibular ocular reflex fails and the eyes make a visible corrective saccade to re-fixate on the visual target <ref>Barraclough K, Bronstein A. Vertigo. BMJ. 2009;339:b3493</ref><ref>Kuo CH, Pang L, Chang R. Vertigo - part 1 - assessment in general practice. Aust Fam Physician. 2008;37(5):341-7</ref>
	#*Normally, a functional vestibular system will identify any movement of the head position and ~~rapidly~~ correct eye movement accordingly so that the center of the vision remains on a target.		#*Normally, a functional vestibular system will identify any movement of the head position and instantaneously correct eye movement accordingly so that the center of the vision remains on a target.
	#**This reflex fails in peripheral causes of vertigo affecting the vestibulocochlear nerve		#**This reflex fails in peripheral causes of vertigo affecting the vestibulocochlear nerve unilaterally; thus, failure of the reflex unilaterally is reassuring (since the cause is peripheral)
	~~#*It is reassuring if~~ the reflex is ~~''abnormal''~~ (~~due to dysfunction of~~ the peripheral ~~nerve~~)		#*Note that in central causes of vertigo, test may show normal reflex response OR failure of the reflex BILATERALLY

	====Nystagmus====		====Nystagmus====
	#Observation for '''nystagmus''' in primary, right, and left gaze		#Observation for '''nystagmus''' in primary, right, and left gaze
	#*No nystagmus (normal) or only horizontal unilateral nystagmus is reassuring		#*No nystagmus (normal) or only horizontal unilateral nystagmus (fast direction only in one direction) is reassuring
	#*Any other type of nystagmus is abnormal, including bidirectional nystagmus		#*Any other type of nystagmus is abnormal, including vertical or bidirectional nystagmus

	====Test of Skew====		====Test of Skew====

Borzi: /* Head Impulse Test */ fixed typo

2021-09-21T11:34:06Z

Head Impulse Test: fixed typo

← Older revision		Revision as of 11:34, 21 September 2021
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	#*When the head is turned towards the affected side, the vestibular ocular reflex fails and the eyes make a corrective saccade to re-fixate on the visual target <ref>Barraclough K, Bronstein A. Vertigo. BMJ. 2009;339:b3493</ref><ref>Kuo CH, Pang L, Chang R. Vertigo - part 1 - assessment in general practice. Aust Fam Physician. 2008;37(5):341-7</ref>		#*When the head is turned towards the affected side, the vestibular ocular reflex fails and the eyes make a corrective saccade to re-fixate on the visual target <ref>Barraclough K, Bronstein A. Vertigo. BMJ. 2009;339:b3493</ref><ref>Kuo CH, Pang L, Chang R. Vertigo - part 1 - assessment in general practice. Aust Fam Physician. 2008;37(5):341-7</ref>
	#*Normally, a functional vestibular system will identify any movement of the head position and rapidly correct eye movement accordingly so that the center of the vision remains on a target.		#*Normally, a functional vestibular system will identify any movement of the head position and rapidly correct eye movement accordingly so that the center of the vision remains on a target.
	#**This reflex fails in peripheral causes of vertigo ~~effective~~ the vestibulocochlear nerve		#**This reflex fails in peripheral causes of vertigo affecting the vestibulocochlear nerve
	#*It is reassuring if the reflex is ''abnormal'' (due to dysfunction of the peripheral nerve)		#*It is reassuring if the reflex is ''abnormal'' (due to dysfunction of the peripheral nerve)

Hoxbox: /* The 3 components of the HINTS exam include: */

2019-12-01T11:45:16Z

The 3 components of the HINTS exam include:

← Older revision		Revision as of 11:45, 1 December 2019
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			====Inclusion Criteria====
			*HINTS exam should only be used in patient with acute persistent vertigo, nystagmus, and a normal neurological exam.

	====The 3 components of the HINTS exam include:====		====The 3 components of the HINTS exam include:====
	{\| {{table}}		{\| {{table}}

ProfOak: /* The 3 components of the HINTS exam include: */

2019-01-17T20:38:55Z

The 3 components of the HINTS exam include:

← Older revision		Revision as of 20:38, 17 January 2019
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	\| align="center" style="background:#f0f0f0;"\|'''Reassuring Finding'''		\| align="center" style="background:#f0f0f0;"\|'''Reassuring Finding'''
	\|-		\|-
	\| Head Impulse Test\|\|Abnormal		\| Head Impulse Test\|\|Abnormal (corrective saccade)
	\|-		\|-
	\| Nystagmus\|\|~~None (normal) or~~ horizontal ~~unilateral only~~		\| Nystagmus\|\|Unidirectional, horizontal
	\|-		\|-
	\| Test of Skew\|\|~~Normal~~		\| Test of Skew\|\|No skew deviation
	\|}		\|}

Kxl328: /* Test of Skew */

2018-10-07T20:33:00Z

Test of Skew

← Older revision		Revision as of 20:33, 7 October 2018
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	#Then rapidly uncover the eye and quickly look to see if the eye moves to re-align.		#Then rapidly uncover the eye and quickly look to see if the eye moves to re-align.
	#Repeat with on each eye		#Repeat with on each eye
	*Skew deviation is a fairly specific predictor of brainstem involvement in patients with acute vestibular syndrome. The presence of skew may help identify stroke when a positive head impulse test falsely suggests a peripheral lesion.		#*Skew deviation is a fairly specific predictor of brainstem involvement in patients with acute vestibular syndrome. The presence of skew may help identify stroke when a positive head impulse test falsely suggests a peripheral lesion.
	*Skew is also known vertical dysconjugate gaze and is a sign of a central lesion		#*Skew is also known vertical dysconjugate gaze and is a sign of a central lesion

Kxl328: /* Nystagmus */

2018-10-07T20:32:45Z

Nystagmus

← Older revision		Revision as of 20:32, 7 October 2018
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	====Nystagmus====		====Nystagmus====
	#Observation for '''nystagmus''' in primary, right, and left gaze		#Observation for '''nystagmus''' in primary, right, and left gaze
	*No nystagmus (normal) or only horizontal unilateral nystagmus is reassuring		#*No nystagmus (normal) or only horizontal unilateral nystagmus is reassuring
	*Any other type of nystagmus is abnormal		#*Any other type of nystagmus is abnormal, including bidirectional nystagmus

	====Test of Skew====		====Test of Skew====

Kxl328: /* Head Impulse Test */

2018-10-07T20:32:08Z

Head Impulse Test

← Older revision		Revision as of 20:32, 7 October 2018
Line 17:		Line 17:
	#*When the head is turned towards the normal side, the vestibular ocular reflex remains intact and eyes continue to fixate on the visual target		#*When the head is turned towards the normal side, the vestibular ocular reflex remains intact and eyes continue to fixate on the visual target
	#*When the head is turned towards the affected side, the vestibular ocular reflex fails and the eyes make a corrective saccade to re-fixate on the visual target <ref>Barraclough K, Bronstein A. Vertigo. BMJ. 2009;339:b3493</ref><ref>Kuo CH, Pang L, Chang R. Vertigo - part 1 - assessment in general practice. Aust Fam Physician. 2008;37(5):341-7</ref>		#*When the head is turned towards the affected side, the vestibular ocular reflex fails and the eyes make a corrective saccade to re-fixate on the visual target <ref>Barraclough K, Bronstein A. Vertigo. BMJ. 2009;339:b3493</ref><ref>Kuo CH, Pang L, Chang R. Vertigo - part 1 - assessment in general practice. Aust Fam Physician. 2008;37(5):341-7</ref>
	*Normally, a functional vestibular system will identify any movement of the head position and rapidly correct eye movement accordingly so that the center of the vision remains on a target.		#*Normally, a functional vestibular system will identify any movement of the head position and rapidly correct eye movement accordingly so that the center of the vision remains on a target.
	**This reflex fails in peripheral causes of vertigo effective the vestibulocochlear nerve		#**This reflex fails in peripheral causes of vertigo effective the vestibulocochlear nerve
	*It is reassuring if the reflex is ''abnormal'' (due to dysfunction of the peripheral nerve)		#*It is reassuring if the reflex is ''abnormal'' (due to dysfunction of the peripheral nerve)

	====Nystagmus====		====Nystagmus====

Rossdonaldson1 at 12:48, 24 April 2018

2018-04-24T12:48:45Z

← Older revision		Revision as of 12:48, 24 April 2018
Line 13:		Line 13:
	====Head Impulse Test====		====Head Impulse Test====
	''Test of vestibulo-ocular reflex function''		''Test of vestibulo-ocular reflex function''
	*Normally, a functional vestibular system will identify any movement of the head position and rapidly correct eye movement accordingly so that the center of the vision remains on a target.
	**This reflex fails in peripheral causes of vertigo effective the vestibulocochlear nerve
	*It is reassuring if the reflex is ''abnormal'' (due to dysfunction of the peripheral nerve)
	#Have patient fix their eyes on your nose		#Have patient fix their eyes on your nose
	#Move their head in the horizontal plane to the left and right		#Move their head in the horizontal plane to the left and right
	#*When the head is turned towards the normal side, the vestibular ocular reflex remains intact and eyes continue to fixate on the visual target		#*When the head is turned towards the normal side, the vestibular ocular reflex remains intact and eyes continue to fixate on the visual target
	#*When the head is turned towards the affected side, the vestibular ocular reflex fails and the eyes make a corrective saccade to re-fixate on the visual target <ref>Barraclough K, Bronstein A. Vertigo. BMJ. 2009;339:b3493</ref><ref>Kuo CH, Pang L, Chang R. Vertigo - part 1 - assessment in general practice. Aust Fam Physician. 2008;37(5):341-7</ref>		#*When the head is turned towards the affected side, the vestibular ocular reflex fails and the eyes make a corrective saccade to re-fixate on the visual target <ref>Barraclough K, Bronstein A. Vertigo. BMJ. 2009;339:b3493</ref><ref>Kuo CH, Pang L, Chang R. Vertigo - part 1 - assessment in general practice. Aust Fam Physician. 2008;37(5):341-7</ref>
			*Normally, a functional vestibular system will identify any movement of the head position and rapidly correct eye movement accordingly so that the center of the vision remains on a target.
			**This reflex fails in peripheral causes of vertigo effective the vestibulocochlear nerve
			*It is reassuring if the reflex is ''abnormal'' (due to dysfunction of the peripheral nerve)

	====Nystagmus====		====Nystagmus====
	*Observation for '''nystagmus''' in primary, right, and left gaze		#Observation for '''nystagmus''' in primary, right, and left gaze
	*No nystagmus (normal) or only horizontal unilateral nystagmus is reassuring		*No nystagmus (normal) or only horizontal unilateral nystagmus is reassuring
	*Any other type of nystagmus is abnormal		*Any other type of nystagmus is abnormal

	====Test of Skew====		====Test of Skew====
	*Skew deviation is a fairly specific predictor of brainstem involvement in patients with acute vestibular syndrome. The presence of skew may help identify stroke when a positive head impulse test falsely suggests a peripheral lesion.
	*Skew is also known vertical dysconjugate gaze and is a sign of a central lesion
	#Have patient look at your nose with their eyes and then cover one eye		#Have patient look at your nose with their eyes and then cover one eye
	#Then rapidly uncover the eye and quickly look to see if the eye moves to re-align.		#Then rapidly uncover the eye and quickly look to see if the eye moves to re-align.
	#Repeat with on each eye		#Repeat with on each eye
			*Skew deviation is a fairly specific predictor of brainstem involvement in patients with acute vestibular syndrome. The presence of skew may help identify stroke when a positive head impulse test falsely suggests a peripheral lesion.
			*Skew is also known vertical dysconjugate gaze and is a sign of a central lesion

Rossdonaldson1 at 12:36, 24 April 2018

2018-04-24T12:36:24Z

← Older revision		Revision as of 12:36, 24 April 2018
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	~~'''~~The 3 components of the HINTS exam include:~~'''~~		====The 3 components of the HINTS exam include:====
	{\| {{table}}		{\| {{table}}
	\| align="center" style="background:#f0f0f0;"\|'''HINTS Test'''		\| align="center" style="background:#f0f0f0;"\|'''HINTS Test'''
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	\|}		\|}

	~~'''~~Head Impulse Test~~:'''~~		====Head Impulse Test====
	:''Test of vestibulo-ocular reflex function''		''Test of vestibulo-ocular reflex function''
	#Normally, a functional vestibular system will identify any movement of the head position and rapidly correct eye movement accordingly so that the center of the vision remains on a target. This reflex fails in peripheral causes of vertigo effective the vestibulocochlear nerve		*Normally, a functional vestibular system will identify any movement of the head position and rapidly correct eye movement accordingly so that the center of the vision remains on a target.
			**This reflex fails in peripheral causes of vertigo effective the vestibulocochlear nerve
			*It is reassuring if the reflex is ''abnormal'' (due to dysfunction of the peripheral nerve)
	#Have patient fix their eyes on your nose		#Have patient fix their eyes on your nose
	#Move their head in the horizontal plane to the left and ~~righ~~		#Move their head in the horizontal plane to the left and right
	#When the head is turned towards the normal side the vestibular ocular reflex remains intact and eyes continue to fixate on the visual target		#*When the head is turned towards the normal side, the vestibular ocular reflex remains intact and eyes continue to fixate on the visual target
	#When the head is turned towards the affected side, the vestibular ocular reflex fails and the eyes make a corrective saccade to re-fixate on the visual target <ref>Barraclough K, Bronstein A. Vertigo. BMJ. 2009;339:b3493</ref><ref>Kuo CH, Pang L, Chang R. Vertigo - part 1 - assessment in general practice. Aust Fam Physician. 2008;37(5):341-7</ref>		#*When the head is turned towards the affected side, the vestibular ocular reflex fails and the eyes make a corrective saccade to re-fixate on the visual target <ref>Barraclough K, Bronstein A. Vertigo. BMJ. 2009;339:b3493</ref><ref>Kuo CH, Pang L, Chang R. Vertigo - part 1 - assessment in general practice. Aust Fam Physician. 2008;37(5):341-7</ref>
	~~#It is reassuring if the reflex is ''abnormal'' (due to dysfunction of the peripheral nerve)~~

	~~'''~~Nystagmus~~'''~~		====Nystagmus====
	#Observation for '''nystagmus''' in primary, right, and left gaze		*Observation for '''nystagmus''' in primary, right, and left gaze
			*No nystagmus (normal) or only horizontal unilateral nystagmus is reassuring
			*Any other type of nystagmus is abnormal

	~~'''~~Test of Skew~~'''~~		====Test of Skew====
	*Skew deviation is a fairly specific predictor of brainstem involvement in patients with acute vestibular syndrome. The presence of skew may help identify stroke when a positive head impulse test falsely suggests a peripheral lesion.		*Skew deviation is a fairly specific predictor of brainstem involvement in patients with acute vestibular syndrome. The presence of skew may help identify stroke when a positive head impulse test falsely suggests a peripheral lesion.
	*Skew is also known vertical dysconjugate gaze and is a sign of a central lesion		*Skew is also known vertical dysconjugate gaze and is a sign of a central lesion
	#Have pt look at your nose with their eyes and then cover one eye		#Have patient look at your nose with their eyes and then cover one eye
	#Then rapidly uncover the eye and quickly look to see if the eye moves to re-align.		#Then rapidly uncover the eye and quickly look to see if the eye moves to re-align.
	#Repeat with on each eye		#Repeat with on each eye