HINTS+ Exam
HINTS+ Exam appears more sensitive than early MRI for detecting stroke in the first 24-48 hours. (Newman-Toker 2009)
When to Use HINTS+?
When there is dizziness from an Acute Vestibular Syndrome (AVS):
1. Continuous vertigo lasting 24 hours or more
2. Nausea, vomiting
3. Spontaneous nystagmus
4. Gait instability
5. No obvious focal neurological deficits
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
Labyrinthitis and vestibular neuritis:
These are 2 different forms of an inner ear infection or acute unilateral vestibulopathy (typically viral in nature) with labyrinthitis resulting in hearing loss. Both have a good prognosis, but evidence based practice includes early referral to vestibular therapy to ensure recovery has been maximized. (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, order a MRI 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 be useful to help rule in a 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 & the Supine Roll test.
Or,
If you would like us to work with your team or associates 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
