HINTS+ Exam
HINTS+ Exam appears more sensitive than early MRI for detecting stroke in the first 24-48 hours. (Kattah 2009)
When Should You Use HINTS+?
Use HINTS+ when a patient presents with Acute Vestibular Syndrome (AVS), characterized by::
1. Constant vertigo/dizziness
2. Nausea, vomiting
3. Spontaneous nystagmus
4. Gait instability
5. Head motion intolerance
Curious what a positive test looks like with the HINTS+?
INFARCT
Impulse
Normal,
Fast-phase
Alternating nystagmus,
Refixation
Cover Test (skew)
= stroke
SEND HIM HOME SAFE
Straight Eyes- No new Deafness
Head Impulses Misses
One-way Nystagmus
Healthy Otic & Mastoid Exam
Stand Alone & Face Even
= peripheral lesion
HINTS+ is a powerful tool when applied to the right patient, at the right time, by a trained examiner.
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Labyrinthitis and vestibular neuritis:
These are two different inner ear conditions: vestibular neuritis (also known as acute unilateral vestibulopathy, or AUVP) and labyrinthitis. Both are typically viral in nature, with labyrinthitis also involving hearing loss. Both generally have a good prognosis, but evidence-based practice supports early referral to vestibular therapy to help maximize recovery. (Tokle 2020)
Labyrinthitis vs AICA Stroke:
- Labyrinthitis = inner ear infection + hearing loss
- AICA strokes can mimic labyrinthitis (peripheral signs plus hearing loss)
- With acute vestibular syndrome (AVS), if hearing loss is present, even with peripheral signs, serial testing and further investigation are warranted to rule out stroke.
Click on the TABLE below👇🏻 to download a more detailed flowchart for vestibular & non-vestibular causes of dizziness.
If you are a physician in Saskatchewan and would like your patient seen by one of our vestibular physical therapists, feel free to send us a referral by fax to 306-343-7780. You can also have your patient call us at 306-343-7776 or use the link below to book a Vestibular Assessment.
Looking for videos to help you perform the following assessment techniques?
Head Impulse Test
Peripheral vestibular hypofunction is a common vestibular condition. In this video we review how to perform the Head Impulse Test (aka head thrust test) which can help identify vestibular hypofunction.
Spontaneous & Gaze-Evoked Nystagmus
In this video we review how to assess for spontaneous and gaze-evoked nystagmus during a vestibular assessment.
Dix-Hallpike & Supine Roll Tests
BPPV is the most common cause of dizziness across the lifespan. In this video we review two techniques to assess for BPPV, being the Dix-Hallpike &Â the Supine Roll tests.
Or,
If you would like us to work with your team or colleagues to review vestibular testing, we would be happy to facilitate this either in-person or online. It would be our honour to assist, and we truly enjoy sharing our expertise.
Feel free to contact Kregg to make arrangements:
(T) 306-343-7776
(E) kregg@north49therapy.ca
Looking for videos demonstrating what positive findings look like for the following conditions?
Looking for some education videos to pass on to your patients?
Who is North 49?
CONTACT INFO
(T) 306-343-7776
(F) 306-343-7780
(E) contactus@north49therapy.ca
