HINTS Exam for Stroke vs Vestibular Neuritis
Head Impulse, Nystagmus, Test of Skew (HINTS). 3-step bedside eye examination to differentiate posterior fossa stroke from peripheral vestibular disorder in acute vestibular syndrome. More sensitive than early MRI.
Score interpretation
All 3 signs peripheral — likely viral vestibular neuritis/labyrinthitis
→ Vestibular suppressants (prochlorperazine); vestibular rehabilitation; antivirals if herpes zoster suspected; discharge if stable
≥1 central sign — posterior fossa stroke must be excluded (sensitivity 96.5% for stroke)
→ URGENT: IV access; blood glucose; CT head (insensitive for posterior fossa stroke in first 24–48h); MRI DWI brain urgently; neurology review; stroke pathway
Interpretation bands for the HINTS Exam. Apply clinical judgement and local guidance.
References
- Kattah JC et al. HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging. Stroke. 2009;40(11):3504–3510.
Related
Curated clinical cross-links plus same-class fallbacks.
- Cinnarizine · Vestibular Suppressant — Vertigo
- Aspirin (Loading Dose) · Antiplatelet — ACS / Ischaemic Stroke
- Alteplase (tPA) · Thrombolytic — Ischaemic Stroke / Massive PE
- Betahistine · Histamine Analogue (Vestibular)
- Betahistine dihydrochloride · Histamine analogue (vestibular)
- Betahistine · Histamine Analogue — Vestibular
- Acute Stroke / TIA Assessment · NICE NG128; RCP Stroke Guidelines 2023
- Status Epilepticus (Adults) · NICE CG137; ESEM guidelines; RCP Neurology Guidelines
- Suspected Subarachnoid Haemorrhage · NICE NG228; RCEM 2023; AHA/ASA 2023
- Adult Head Injury · NICE NG232 (2023)
- Bell's Palsy / Facial Nerve Palsy · ENT UK 2017; AAN
- Vertigo Workup · ENT UK; NICE CKS
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.