HINTS Plus (Central vs Peripheral Vertigo)
Differentiates central (stroke) from peripheral vertigo using Head Impulse, Nystagmus, Test of Skew (HINTS) plus hearing loss. Outperforms early MRI for posterior fossa stroke.
Score interpretation
→ Peripheral vestibular disorder (labyrinthitis, vestibular neuritis); Epley if BPPV; prochlorperazine; neurology follow-up in 2 weeks if not improving
→ Neurology/ENT review; MRI brain with DWI at 24-48h (early MRI may be falsely negative for posterior fossa stroke)
→ Urgent stroke team activation; MRI DWI (even if CT negative); aspirin; admit; cerebellar stroke can cause life-threatening oedema
Interpretation bands for the HINTS Plus Vertigo. Apply clinical judgement and local guidance.
References
Related
Curated clinical cross-links plus same-class fallbacks.
- Cinnarizine · Vestibular Suppressant — Vertigo
- Unfractionated Heparin (Peripheral/Central Line Flush) · Anticoagulant flush / catheter maintenance
- Olmesartan with hydrochlorothiazide · ARB + thiazide
- Perindopril arginine with indapamide · ACE inhibitor + thiazide-like diuretic
- Tretinoin with erythromycin · Retinoid + topical antibiotic
- Emollients, urea-containing · Topical emollient (urea, keratolytic)
- Adult Upper Airway Obstruction (Stridor) · DAS 2015 unanticipated difficult airway; RCEM
- Epistaxis Management · ENT-UK / NICE
- Acute Otitis Media · NICE NG91 2018
- Tonsillitis and Sore Throat · NICE NG84 2018
- Benign Paroxysmal Positional Vertigo · NICE CG124 / AAO-HNS Guidelines
- Acute Rhinosinusitis · NICE NG79 2017 / EPOS 2020
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.