Scribd
Upload
1K views12 pages

Hints Exam Presentation

The HINTS exam is used to assess for central versus peripheral vestibular involvement and predict brainstem strokes. It consists of 3 parts: head impulse test, nystagmus test, and test of skew. The head impulse test assesses the vestibulo-ocular reflex by observing eye movement during head turns. Nystagmus is observed in eccentric gazes to identify pattern. The test of skew covers one eye to observe for corrective eye movement, indicating central involvement. Together, these tests can indicate reassuring peripheral involvement or concerning central involvement suggestive of brainstem stroke. The HINTS exam is appropriate for evaluating recent continuous vertigo and spontaneous nystagmus.

Uploaded by

api-362395776
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
1K views12 pages

Hints Exam Presentation

The HINTS exam is used to assess for central versus peripheral vestibular involvement and predict brainstem strokes. It consists of 3 parts: head impulse test, nystagmus test, and test of skew. The head impulse test assesses the vestibulo-ocular reflex by observing eye movement during head turns. Nystagmus is observed in eccentric gazes to identify pattern. The test of skew covers one eye to observe for corrective eye movement, indicating central involvement. Together, these tests can indicate reassuring peripheral involvement or concerning central involvement suggestive of brainstem stroke. The HINTS exam is appropriate for evaluating recent continuous vertigo and spontaneous nystagmus.

Uploaded by

api-362395776
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
You are on page 1/ 12

HINTS EXAM

Grace Blankenhagen, SPT


What is the HINTS exam?

■ Purpose:
– Assess for central vestibular involvement1,2
– Assess presence of stroke1,2
– Ability to predict brainstem stroke2
■ 3 Components:
– Head Impulse
– Nystagmus
– Test of Skew
Head Impulse1,3

■ Can be done in seated or supine


– Supine is best for complete relaxation of cervical muscles
■ Have patient fixate on something
– Volunteer your nose
■ Passively rotate their head side to side
■ Initiate a quick turn
■ Assess for loss of target
Head Impulse- Interpreting Results1,3

■ Peripheral Vestibular Dysfunction


– Loss of target + corrective saccade
– Due to impaired VOR reflex
– Considered “positive” or “abnormal”
– Is ideal result- indicates peripheral involvement
■ Central Vestibular Dysfunction
– Loss of target and no corrective saccade
– Considered “negative” or “normal”
– Indicates central involvement when VOR reflex is intact and complaints of
vertigo are present
Nystagmus1,2

■ Assess for nystagmus in eccentric gaze


■ Peripheral Involvement
– Unidirectional
– Horizontal
■ Central Involvement
– Multidirectional
– Can be horizontal, vertical, or rotational
Test of Skew1

■ Seated or Supine
■ Cover one eye with paper or your hand
■ Instruct patient to keep eyes open and focused on something
■ Quickly remove your hand and observe for motion
■ Peripheral Involvement
– No movement of covered eye
■ Central Involvement
– Vertical or torsional movements of covered eye to correct
What is Test of Skew1,2

■ Central involvement typically has an imbalance between


right and left side gravity sensing function
■ Leads to vertical malalignment in eyes
■ Covering/uncovering the eye causes them to realign which
can be observed
■ Pathological ocular tilt reaction
Recap:

■ Reassuring Exam:
– Loss of target with corrective saccade
– Unidirectional, horizontal nystagmus in eccentric gaze
– Test of skew normal with no motion in eye

■ Concerning Exam (any one of the following):


– Loss of target with no corrective saccade or no loss of target
– Multidirectional, vertical, or rotational nystagmus in eccentric gaze
– Test of skew abnormal for vertical or torsional motion in covered eye
*central lesions may also present with unilateral hearing loss2
Which Patients are Appropriate?

■ Perform on patients with hours or days of continuous vertigo


and spontaneous nystagmus
Example3

■ https://www.youtube.com/watch?v=1q-VTKPweuk
References

1. Weingart S. Take a HINTS. Emergency Physicians Monthly. 2015.


http://epmonthly.com/article/take-a-hints/. Accessed November 15, 2017.
2. Kattah JC, Talkad AV, Wang DZ, Hsieh YU, Newman-Toker DE. HINTS to diagnose
stroke in the acute vestibular syndrome. Stroke. 2009;40:3504-3510. doi:
https://doi.org/10.1161/STROKEAHA.109.551234.
3. Johns P. The HINTS exam in vertigo. Available at:
https://www.youtube.com/watch?v=1q-VTKPweuk. Accessed November 15, 2017.
Questions?

Retrieved from: http://draconicmagazine.com/articles/david-s-pumpkins

You might also like