HINTS Plus (Central vs Peripheral Vertigo)
Differentiates central (stroke) from peripheral causes of the acute vestibular syndrome — continuous vertigo with spontaneous nystagmus — using Head Impulse, Nystagmus, Test of Skew (HINTS) plus new hearing loss. In trained hands more sensitive than early MRI for posterior fossa stroke.
Score interpretation
Abnormal head impulse, direction-fixed horizontal nystagmus, no skew, no new hearing loss.
→ Consistent with vestibular neuritis / labyrinthitis when examined by a trained clinician; short course of a vestibular suppressant, early vestibular rehabilitation; review if not improving or new neurological signs.
Any one central sign (Kattah 2009; HINTS plus, Newman-Toker 2013).
→ Urgent stroke team activation; MRI DWI (even if CT negative; early MRI can miss posterior fossa stroke); 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.