🌀 HINTS Exam (Acute Vestibular Syndrome)
UseWhen to use: ongoing AVS examined by a trained clinician; continuous vertigo with nystagmus.
StrataCentral pattern prompts stroke work-up; peripheral pattern supports neuritis only without red flags.
LimitsWhen not to use: episodic positional vertigo (use Dix–Hallpike), untr… · Pitfall: calling HIT 'normal' when the patient is not generating adeq… · Focal neuro signs, inability to walk, headache/neck pain override a p…
SourceAHA/ASA / vestibular stroke literature as cited on tool page
This-shift next steps
After scoring: open the scene pack, peer scores, and the matching pathway. Local reference — no HIS write.
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Methodology · worked example, guidelines & full notes
INFARCT mnemonic for central pattern.
When to use
When to use: ongoing AVS examined by a trained clinician; continuous vertigo with nystagmus.
How it works
Any central-pattern finding (normal impulse / direction-changing or vertical-torsional nystagmus / skew) → concerning for central; all peripheral-pattern → supports peripheral.
Key points
- INFARCT mnemonic for central pattern.
- Requires skilled HIT.
- Next: stroke pathway imaging when central features present.
References
- [Guideline / primary source]AHA/ASA / vestibular stroke literature as cited on tool page
- Kattah JC, et al. Stroke 2009 (HINTS)
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| Head Impulse Test | Abnormal (corrective saccade) — peripheral pattern |
|---|---|
| Nystagmus | Unidirectional horizontal — peripheral pattern |
| Test of Skew (cover–uncover) | No vertical skew — peripheral pattern |
→HINTS patternConsistent with PERIPHERAL
- Central features present：None of the three
- INFARCT mnemonic：Impulse Normal, Fast-phase Alternating, Refixation on Cover Test → central
| Head Impulse Test | Normal (no corrective saccade) — concerning for central |
|---|---|
| Nystagmus | Direction-changing, vertical or torsional — central pattern |
| Test of Skew (cover–uncover) | Vertical skew / refixation — central pattern |
→HINTS patternConcerning for CENTRAL
- Central features present：normal head impulse; central-pattern nystagmus; skew deviation
- INFARCT mnemonic：Impulse Normal, Fast-phase Alternating, Refixation on Cover Test → central
Verification & sources · governance
FAQ
Frequently asked questions
- Does HINTS Exam (Acute Vestibular Syndrome) upload patient data? Where is it calculated?
- Calculation runs locally in the browser; inputs and results are not uploaded. For licensed clinicians only; interpret with history, investigations and local protocols — not a diagnosis or prescription.
- How is HINTS Exam (Acute Vestibular Syndrome) calculated in practice? Can you show a worked example?
- Inputs: Head Impulse Test Abnormal (corrective saccade) — peripheral pattern, Nystagmus Unidirectional horizontal — peripheral pattern, Test of Skew (cover–uncover) No vertical skew — peripheral pattern → Result: HINTS pattern Consistent with PERIPHERAL（Central features present: None of the three, INFARCT mnemonic: Impulse Normal, Fast-phase Alternating, Refixation on Cover Test → central） Inputs: Head Impulse Test Normal (no corrective saccade) — concerning for central, Nystagmus Direction-changing, vertical or torsional — central pattern, Test of Skew (cover–uncover) Vertical skew / refixation — central pattern → Result: HINTS pattern Concerning for CENTRAL（Central features present: normal head impulse; central-pattern nystagmus; skew deviation, INFARCT mnemonic: Impulse Normal, Fast-phase Alternating, Refixation on Cover Test → central）