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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 ... PhysicalExam #Testing #Vertigo ... Central #Peripheral #Neurology
Diagnostic Algorithm for Dizziness and Vertigo
Peripheral Vertigo:
 • Attacks: Sudden, severe, can last anywhere from seconds
Varies • No neurologic ... Can worsen with head ... position change • Neurologic ... Positive head impulse ... differential #diagnosis #neurology
HINTS Exam - Abnormal Head Impulse Test = Peripheral Cause

This video demonstrates:
1) Normal Head Impulse Test
Exam - Abnormal Head ... demonstrates: 1) Normal Head ... Left 2) Abnormal Head ... a patient with vertigo ... Clinical #Video #Neurology
HINTS Exam - Normal Head Impulse Test = Central Cause

This patient as a normal head impulse
Exam - Normal Head ... patient as a normal head ... 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
Exam - Abnormal Head ... demonstrates: 1) Normal Head ... Left 2) Abnormal Head ... a patient with vertigo ... Clinical #Video #Neurology
Causes of Peripheral and Central Vertigo
PERIPHERAL VERTIGO
1. Benign paroxysmal positional vertigo (BPPV) - Short-lived (typically less
with significant neurologic ... Head trauma - Symptoms ... shortly after head ... attacks with varying neurologic ... differential #diagnosis #neurology
HINTS Exam - Distinguishing Central from Peripheral Vertigo
 • Head Impulse: Head thrust 10° with eyes
from Peripheral Vertigo ... • Head Impulse ... : Head thrust 10 ... Central #Peripheral #Vertigo ... #diagnosis #neurology
Characteristics of Peripheral and Central Vertigo
PERIPHERAL VERTIGO
 • Onset: Sudden
 • Intensity: Severe initially, often decreasing
PERIPHERAL VERTIGO ... labyrinthitis • Head ... toward nose) • Head ... can worsen with head ... symptoms #comparison #neurology
Dizziness and Vertigo Algorithm
Presyncope:
 • Feels "faint" or like they are going to "pass out"
 •
Dizziness and Vertigo ... consciousness Vertigo ... movement of the head ... #Dizziness #Vertigo ... differential #diagnosis #neurology
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