Template:HINTS Exam Procedure: Difference between revisions
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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 | #**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) | ||
Revision as of 11:34, 21 September 2021
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:
| HINTS Test | Reassuring Finding |
| Head Impulse Test | Abnormal (corrective saccade) |
| Nystagmus | Unidirectional, horizontal |
| Test of Skew | No skew deviation |
Head Impulse Test
Test of vestibulo-ocular reflex function
- Have patient fix their eyes on your nose
- 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 affected side, the vestibular ocular reflex fails and the eyes make a corrective saccade to re-fixate on the visual target [1][2]
- 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 affecting the vestibulocochlear nerve
- 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
- No nystagmus (normal) or only horizontal unilateral nystagmus is reassuring
- Any other type of nystagmus is abnormal, including bidirectional nystagmus
Test of Skew
- 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.
- 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