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The HINTS Exam - Differentiating Central vs Peripheral Vertigo

Head Impulse Test
Nystagmus
Test of Skew

Animation by Dr. Y.
The HINTS Exam - ... Differentiating Central ... vs Peripheral Vertigo ... Head Impulse Test ... Nystagmus Test
HINTS Exam - Abnormal Test of Skew (Abnormal Vertical Skew)

In a patient with vertigo symptoms, this
HINTS Exam - Abnormal ... Test of Skew (Abnormal ... worrisome for a CENTRAL ... Vertical #Skew #Test ... #Central
HINTS Exam - Normal Head Impulse Test = Central Cause

This patient as a normal head impulse
HINTS Exam - Normal ... Head Impulse Test ... = Central Cause ... #HINTS #PhysicalExam ... #Central
Causes of Peripheral and Central Vertigo

Peripheral Vertigo:
 - Benign Positional Vertigo
 - Vestibular Neuronitis
 - Meniere's
Peripheral and Central ... Vertigo: - Benign ... Positional Vertigo ... Acoustic Neuroma Central ... #Causes #Central
Diagnostic Algorithm for Dizziness and Vertigo
Peripheral Vertigo:
 • Attacks: Sudden, severe, can last anywhere from seconds
Diagnostic Algorithm ... may be present Central ... worsen with head position ... • Short-lived, positional ... #Algorithm #differential
HINTS Exam - Distinguishing Central from Peripheral Vertigo
 • Head Impulse: Head thrust 10° with eyes
HINTS Exam - Distinguishing ... Central from Peripheral ... Vertigo • Head ... following a finger) • Test ... TylerLarsenMD #HINTS
Classic Findings During Hallpike Test in Posterior Canal Benign Paroxysmal Positional Vertigo (BPPV)
 • Latency (delay
During Hallpike Test ... Benign Paroxysmal Positional ... in head-hanging position ... in head-hanging position ... in head-hanging position
Differentiating Benign Paroxysmal Positional Vertigo (BPPV) From Vestibular Neuritis-Labyrinthitis
BENIGN PAROXYSMAL POSITIONAL VERTIGO
 • Age: More common
Benign Paroxysmal Positional ... Vertigo (BPPV) ... BENIGN PAROXYSMAL POSITIONAL ... VERTIGO • Age ... in head-hanging position
Causes of Peripheral and Central Vertigo
PERIPHERAL VERTIGO
1. Benign paroxysmal positional vertigo (BPPV) - Short-lived (typically less
Benign paroxysmal positional ... than 30 seconds), positional ... worsened with positional ... CENTRAL VERTIGO ... Positional symptoms
Peripheral and Central Causes of Vertigo
Peripheral Causes (Common):
 - Labyrinth: Benign paroxysmal positional vertigo, Méniére disease,
Peripheral and Central ... Causes of Vertigo ... Benign paroxysmal positional ... vertigo, Méniére ... vertigo"), Ramsay