Template:HINTS Exam Procedure: Difference between revisions
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====The 3 components of the HINTS exam include:==== | |||
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====Head Impulse Test==== | |||
''Test of vestibulo-ocular reflex function'' | |||
*Normally, a functional vestibular system will identify any movement of the head position and rapidly correct eye movement accordingly so that the center of the vision remains on a target. | |||
**This reflex fails in peripheral causes of vertigo effective the vestibulocochlear nerve | |||
*It is reassuring if the reflex is ''abnormal'' (due to dysfunction of the peripheral nerve) | |||
#Have patient fix their eyes on your nose | #Have patient fix their eyes on your nose | ||
#Move their head in the horizontal plane to the left and | #Move their head in the horizontal plane to the left and right | ||
#When the head is turned towards the normal side the vestibular ocular reflex remains intact and eyes continue to fixate on the visual target | #*When the head is turned towards the normal side, the vestibular ocular reflex remains intact and eyes continue to fixate on the visual target | ||
#When the head is turned towards the affected side, the vestibular ocular reflex fails and the eyes make a corrective saccade to re-fixate on the visual target <ref>Barraclough K, Bronstein A. Vertigo. BMJ. 2009;339:b3493</ref><ref>Kuo CH, Pang L, Chang R. Vertigo - part 1 - assessment in general practice. Aust Fam Physician. 2008;37(5):341-7</ref> | #*When the head is turned towards the affected side, the vestibular ocular reflex fails and the eyes make a corrective saccade to re-fixate on the visual target <ref>Barraclough K, Bronstein A. Vertigo. BMJ. 2009;339:b3493</ref><ref>Kuo CH, Pang L, Chang R. Vertigo - part 1 - assessment in general practice. Aust Fam Physician. 2008;37(5):341-7</ref> | ||
====Nystagmus==== | |||
*Observation for '''nystagmus''' in primary, right, and left gaze | |||
*No nystagmus (normal) or only horizontal unilateral nystagmus is reassuring | |||
*Any other type of nystagmus is abnormal | |||
====Test of Skew==== | |||
*Skew deviation is a fairly specific predictor of brainstem involvement in patients with acute vestibular syndrome. The presence of skew may help identify stroke when a positive head impulse test falsely suggests a peripheral lesion. | *Skew deviation is a fairly specific predictor of brainstem involvement in patients with acute vestibular syndrome. The presence of skew may help identify stroke when a positive head impulse test falsely suggests a peripheral lesion. | ||
*Skew is also known vertical dysconjugate gaze and is a sign of a central lesion | *Skew is also known vertical dysconjugate gaze and is a sign of a central lesion | ||
#Have | #Have patient look at your nose with their eyes and then cover one eye | ||
#Then rapidly uncover the eye and quickly look to see if the eye moves to re-align. | #Then rapidly uncover the eye and quickly look to see if the eye moves to re-align. | ||
#Repeat with on each eye | #Repeat with on each eye | ||
Revision as of 12:36, 24 April 2018
The 3 components of the HINTS exam include:
| HINTS Test | Reassuring Finding |
| Head Impulse Test | Abnormal |
| Nystagmus | None (normal) or horizontal unilateral only |
| Test of Skew | Normal |
Head Impulse Test
Test of vestibulo-ocular reflex function
- Normally, a functional vestibular system will identify any movement of the head position and rapidly correct eye movement accordingly so that the center of the vision remains on a target.
- This reflex fails in peripheral causes of vertigo effective the vestibulocochlear nerve
- It is reassuring if the reflex is abnormal (due to dysfunction of the peripheral nerve)
- Have patient fix their eyes on your nose
- Move their head in the horizontal plane to the left and right
- When the head is turned towards the normal side, the vestibular ocular reflex remains intact and eyes continue to fixate on the visual target
- When the head is turned towards the affected side, the vestibular ocular reflex fails and the eyes make a corrective saccade to re-fixate on the visual target [1][2]
Nystagmus
- Observation for nystagmus in primary, right, and left gaze
- No nystagmus (normal) or only horizontal unilateral nystagmus is reassuring
- Any other type of nystagmus is abnormal
Test of Skew
- Skew deviation is a fairly specific predictor of brainstem involvement in patients with acute vestibular syndrome. The presence of skew may help identify stroke when a positive head impulse test falsely suggests a peripheral lesion.
- Skew is also known vertical dysconjugate gaze and is a sign of a central lesion
- Have patient look at your nose with their eyes and then cover one eye
- Then rapidly uncover the eye and quickly look to see if the eye moves to re-align.
- Repeat with on each eye