HINTS Exam for Stroke in Acute Vestibular Syndrome
Head Impulse, Nystagmus, Test of Skew (HINTS). A bedside oculomotor examination to differentiate central (stroke) from peripheral (vestibular neuritis) cause of acute vestibular syndrome. More sensitive than early MRI.
Score interpretation
→ HINTS Central Pattern: At least one central sign (normal HIT, direction-changing nystagmus, or skew deviation). HIGH suspicion for posterior circulation stroke. Urgent MRI/DWI (note: may be false-negative <48h). Stroke team activation; admit; antiplatelet/anticoagulation per aetiology.
→ HINTS Peripheral Pattern: All three peripheral signs (abnormal HIT, unidirectional nystagmus, no skew). Low probability of stroke (~0%). Consistent with vestibular neuritis. Vestibular suppressants (prochlorperazine); corticosteroids (prednisolone); Epley manoeuvre if BPPV suspected; outpatient follow-up.
Interpretation bands for the HINTS Exam. Apply clinical judgement and local guidance.
References
Related
Curated clinical cross-links plus same-class fallbacks.
- Glyceryl Trinitrate (Sublingual / IV) · Nitrate / Acute Angina
- Dobutamine (Acute HF / Stress Echo) · Inotrope / Acute Heart Failure
- Milrinone · Inodilator / Acute Heart Failure
- Prednisolone (Systemic) · Systemic Corticosteroid — Acute Dermatoses
- Aspirin (Loading Dose) · Antiplatelet — ACS / Ischaemic Stroke
- Alteplase (tPA) · Thrombolytic — Ischaemic Stroke / Massive PE
- 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.