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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
Diagnostic Algorithm for Dizziness and Vertigo
Peripheral Vertigo:
 • Attacks: Sudden, severe, can last anywhere from seconds
Diagnostic Algorithm ... Peripheral Vertigo ... may be present Central ... worsen with head position ... • Short-lived, positional
Causes of Peripheral and Central Vertigo

Peripheral Vertigo:
 - Benign Positional Vertigo
 - Vestibular Neuronitis
 - Meniere's
Causes of Peripheral ... and Central Vertigo ... Peripheral Vertigo ... : - Benign Positional ... #Peripheral
Characteristics of Peripheral and Central Vertigo
PERIPHERAL VERTIGO
 • Onset: Sudden
 • Intensity: Severe initially, often decreasing
Characteristics of Peripheral ... and Central Vertigo ... PERIPHERAL VERTIGO ... labyrinthitis) CENTRAL ... #Central #Vertigo
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 ... with repeated testing ... #physicalexam #testing
Algorithm for the diagnostic evaluation of dizziness. (HINTS = head-impulse, nystagmus, test of skew.)
Questions regarding the
diagnostic evaluation ... head-impulse, nystagmus, test ... or central in etiology ... or central TiTrATE ... of dizziness or vertigo
Peripheral and Central Causes of Vertigo
Peripheral Causes (Common):
 - Labyrinth: Benign paroxysmal positional vertigo, Méniére disease,
Peripheral and Central ... Causes of Vertigo ... Peripheral Causes ... Benign paroxysmal positional ... #Peripheral #Central
Causes of Peripheral and Central Vertigo
PERIPHERAL VERTIGO
1. Benign paroxysmal positional vertigo (BPPV) - Short-lived (typically less
Causes of Peripheral ... and Central Vertigo ... PERIPHERAL VERTIGO ... CENTRAL VERTIGO ... #Peripheral #Central
Causes of Vertigo - Differential Diagnosis Algorithm
#Diagnosis #Neurology #Dizziness #Peripheral #Central #Algorithm #BPPV #Differential #Ddxof
Causes of Vertigo ... Differential Diagnosis Algorithm ... Neurology #Dizziness #Peripheral ... #Central #Algorithm
Peripheral Vertigo
Time course and symptoms characteristics are very helpful in distinguishing between causes of peripheral vertigo.
Benign
Peripheral Vertigo ... between causes of peripheral ... Benign Paroxysmal Positional ... Recurrent episodes lasting ... Chiefs @jmcchiefs #Peripheral