Template:HINTS Exam Procedure: Difference between revisions

Revision as of 12:29, 24 April 2018

The 3 components of the HINTS exam include:

HINTS Test	Reassuring Finding
Head Impulse Test	Abnormal
Nystagmus	None (normal) or horizontal unilateral only
Test of Skew	Normal

Head Impulse Test:

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
Have patient fix their eyes on your nose
Move their head in the horizontal plane to the left and righ
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 ^[1]^[2]
It is reassuring if the reflex is abnormal (due to dysfunction of the peripheral nerve)

Nystagmus

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 pt 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.
Repeat with on each eye

↑ Barraclough K, Bronstein A. Vertigo. BMJ. 2009;339:b3493
↑ Kuo CH, Pang L, Chang R. Vertigo - part 1 - assessment in general practice. Aust Fam Physician. 2008;37(5):341-7

@@ Line 1: / Line 1: @@
 '''The 3 components of the HINTS exam include:'''
-#Head impulse test of vestibulo-ocular reflex function
+{| {{table}}
-#Observation for '''nystagmus''' in primary, right, and left gaze
+| align="center" style="background:#f0f0f0;"|'''HINTS Test'''
-#Alternate cover '''test for skew deviation'''.
+| align="center" style="background:#f0f0f0;"|'''Reassuring Finding'''
+|-
+| Head Impulse Test||Abnormal
+|-
+| Nystagmus||None (normal) or horizontal unilateral only
+|-
+| Test of Skew||Normal
+|}
 '''Head Impulse Test:'''
+:''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
 #Have patient fix their eyes on your nose
@@ Line 11: / Line 19: @@
 #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'''
+#Observation for '''nystagmus''' in primary, right, and left gaze
 '''Test of Skew'''