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The HINTS Exam - Differentiating Central vs Peripheral Vertigo

Head Impulse Test
Nystagmus
Test of Skew

Animation by Dr. Y.
vs Peripheral Vertigo ... Head Impulse Test ... Nystagmus Test ... PhysicalExam #Testing #Vertigo ... Central #Peripheral #Neurology
HINTS Exam - Abnormal Test of Skew (Abnormal Vertical Skew)

In a patient with vertigo symptoms, this
Exam - Abnormal Test ... a patient with vertigo ... Vertical #Skew #Test ... Clinical #Video #Neurology ... #Vertigo #Central
Diagnostic Algorithm for Dizziness and Vertigo
Peripheral Vertigo:
 • Attacks: Sudden, severe, can last anywhere from seconds
Varies • No neurologic ... position change • Neurologic ... Positive Hallpike test ... or supine roll test ... Positive head impulse test
HINTS Exam - Normal Test of Skew (Normal Vertical Skew)

In a patient with vertigo symptoms, this
Exam - Normal Test ... a patient with vertigo ... Vertical #Skew #Test ... Clinical #Video #Neurology ... #Vertigo #Peripheral
HINTS Exam - Abnormal Head Impulse Test = Peripheral Cause

This video demonstrates:
1) Normal Head Impulse Test
Abnormal Head Impulse Test ... a patient with vertigo ... PERIPHERAL cause of vertigo ... Clinical #Video #Neurology ... #Vertigo #Peripheral
HINTS Exam - Normal Head Impulse Test = Central Cause

This patient as a normal head impulse
Normal Head Impulse Test ... normal head impulse test ... a patient with vertigo ... Clinical #Video #Neurology ... #Vertigo #Central
HINTS Exam - Abnormal Head Impulse Test = Peripheral Cause

This video demonstrates:
1) Normal Head Impulse Test
Abnormal Head Impulse Test ... a patient with vertigo ... PERIPHERAL cause of vertigo ... Clinical #Video #Neurology ... #Vertigo #Peripheral
Differentiating Benign Paroxysmal Positional Vertigo (BPPV) From Vestibular Neuritis-Labyrinthitis
BENIGN PAROXYSMAL POSITIONAL VERTIGO
 • Age: More common
Paroxysmal Positional Vertigo ... PAROXYSMAL POSITIONAL VERTIGO ... reproduction of vertigo ... (2 to 11%) #Vertigo ... Labyrinthitis #diagnosis #neurology
HINTS Exam - Distinguishing Central from Peripheral Vertigo
 • Head Impulse: Head thrust 10° with eyes
from Peripheral Vertigo ... following a finger) • Test ... Central #Peripheral #Vertigo ... #diagnosis #neurology
Causes of Peripheral and Central Vertigo
PERIPHERAL VERTIGO
1. Benign paroxysmal positional vertigo (BPPV) - Short-lived (typically less
PERIPHERAL VERTIGO ... insufficiency (VBI) - Should ... with significant neurologic ... attacks with varying neurologic ... differential #diagnosis #neurology