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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 ... #Peripheral #Neurology
Diagnostic Algorithm for Dizziness and Vertigo
Peripheral Vertigo:
 • Attacks: Sudden, severe, can last anywhere from seconds
Varies • No neurologic ... with vascular causes ... positional episodes caused ... Positive Hallpike test ... or supine roll test
HINTS Exam - Abnormal Test of Skew (Abnormal Vertical Skew)

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

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

In a patient with vertigo symptoms, this
Exam - Normal Test ... for a PERIPHERAL cause ... of vertigo. ... Vertical #Skew #Test ... Clinical #Video #Neurology
HINTS Exam - Normal Head Impulse Test = Central Cause

This patient as a normal head impulse
Normal Head Impulse Test ... = Central Cause ... for a CENTRAL cause ... of vertigo. ... Clinical #Video #Neurology
HINTS Exam - Abnormal Head Impulse Test = Peripheral Cause

This video demonstrates:
1) Normal Head Impulse Test
= Peripheral Cause ... a patient with vertigo ... for a PERIPHERAL cause ... of vertigo. ... Clinical #Video #Neurology
Classic Findings During Hallpike Test in Posterior Canal Benign Paroxysmal Positional Vertigo (BPPV)
 • Latency (delay
During Hallpike Test ... nystagmus and vertigo ... toward the downward ear ... with repeated testing ... #physicalexam #testing
HINTS Exam - Unidirectional Nystagmus - Left-beating

In a patient with vertigo symptoms, this finding is reassuring
Nystagmus - Left-beating ... a patient with vertigo ... for a PERIPHERAL cause ... of vertigo. ... Video #Negative #Neurology
Causes of Peripheral and Central Vertigo
PERIPHERAL VERTIGO
1. Benign paroxysmal positional vertigo (BPPV) - Short-lived (typically less
Causes of Peripheral ... usually lasting ... without an obvious cause ... #Causes #differential ... #diagnosis #neurology