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The HINTS Exam - Differentiating Central vs Peripheral Vertigo

Head Impulse Test
Nystagmus
Test of Skew

Animation by Dr. Y.
Differentiating Central vs ... Peripheral Vertigo ... Nystagmus Test ... #PhysicalExam #Testing ... #Peripheral #Neurology
Peripheral and Central Causes of Vertigo
Peripheral Causes (Common):
 - Labyrinth: Benign paroxysmal positional vertigo, Méniére disease,
Peripheral and Central ... Peripheral Causes ... often classified as ... #Causes #differential ... #diagnosis #neurology
Characteristics of Peripheral and Central Vertigo
PERIPHERAL VERTIGO
 • Onset: Sudden
 • Intensity: Severe initially, often decreasing
Characteristics of Peripheral ... PERIPHERAL VERTIGO ... can be severe in stroke ... vascular causes, such as ... symptoms #comparison #neurology
Diagnostic Algorithm for Dizziness and Vertigo
Peripheral Vertigo:
 • Attacks: Sudden, severe, can last anywhere from seconds
Diagnostic Algorithm ... Peripheral Vertigo ... or supine roll test ... #Algorithm #differential ... #diagnosis #neurology
Algorithm for the diagnostic evaluation of dizziness. (HINTS = head-impulse, nystagmus, test of skew.)
Questions regarding the
head-impulse, nystagmus, test ... the dizziness as ... more likely to be peripheral ... of dizziness or vertigo ... #Differential #
Causes of Tremors - Movement Disorders - Differential Diagnosis Algorithm
Action Tremor - Occurs During Voluntary Muscle
Diagnosis Algorithm ... E deficiency, stroke ... multiple sclerosis) Resting ... Tremor - Occurs at Rest ... #Differential #
Diagnostic algorithm for differentiating vestibular neuritis from stroke in patients with AVS. This sequence of testing
neuritis from stroke ... sensitivity for stroke ... if the cause is peripheral ... , Head Impulse Test ... Nystagmus, and Test
Preoperative Risk Evaluation

Major Pre-Op Questions:
1. Does the patient have any modifiable risk factors that could be
event, follow ACC algorithm ... determine if stress test ... - Aortic - Peripheral ... • <6mo since stroke ... surgery Stress Testing
Evaluation of Recurrent Falls

Core Concept:
Maintaining an upright posture requires the integrated function of multiple systems.
Disruption in
paroxysmal positional vertigo ... neuritis • Clues: Vertigo ... Examples: - Peripheral ... neuron disease (ALS ... Falls #Diagnosis #Differential