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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 ... Head Impulse Test ... Nystagmus Test ... #PhysicalExam #Testing ... #Peripheral #Neurology
HINTS Exam - Distinguishing Central from Peripheral Vertigo
 • Head Impulse: Head thrust 10° with eyes
Distinguishing Central ... following a finger) • Test ... Vertigo #diagnosis #neurology ... #bppv #comparison ... #table
Characteristics of Peripheral and Central Vertigo
PERIPHERAL VERTIGO
 • Onset: Sudden
 • Intensity: Severe initially, often decreasing
Peripheral and Central ... than a minute for BPPV ... labyrinthitis) CENTRAL ... #Peripheral #Central ... symptoms #comparison #neurology
The head impulse test (HIT) result is positive (abnormal) in nearly all patients with a peripheral
The head impulse test ... patients with a central ... a stand-alone test ... #PhysicalExam #Neurology ... #HeadImpulse #Testing
Diagnostic Algorithm for Dizziness and Vertigo
Peripheral Vertigo:
 • Attacks: Sudden, severe, can last anywhere from seconds
Varies • No neurologic ... may be present Central ... auditory findings BPPV ... or supine roll test ... differential #diagnosis #neurology
Commonly Used Diagnostic Tests for Celiac Disease

Tissue transglutaminase (tTG) IgA antibodies
 - Most reliable noninvasive test
Used Diagnostic Tests ... Reflects response to treatment ... Celiac #Disease #Testing ... #Diagnosis #Workup ... #Table
Dix-Hallpike Maneuver for BPPV

Procedure:
1. Make the patient sit on examination table, such that the shoulders would
Dix-Hallpike Maneuver for BPPV ... 45° towards the test ... throughout the test ... DixHallpike #Maneuver #BPPV ... Instructions #Diagnosis #neurology
Causes of Peripheral and Central Vertigo
PERIPHERAL VERTIGO
1. Benign paroxysmal positional vertigo (BPPV) - Short-lived (typically less
Peripheral and Central ... positional vertigo (BPPV ... CENTRAL VERTIGO ... #Peripheral #Central ... differential #diagnosis #neurology
The rationale for aggressive treatment of generalized status epilepticus was described previously here.  In short,
for aggressive treatment ... In short, best outcomes ... rapid seizure control ... #Management #Neurology
Dix-HaIlpike Maneuver
 • Turn head to 45° and then rapidly lay patient to a supine position
20° over end of table ... The test is positive ... HaIlpike #Maneuver #neurology ... #vertigo #bppv