The HINTS examination can be used to differentiate central from peripheral causes of dizziness and nystagmus. Recently the effectiveness of this examination in the hands of emergency physicians has come under fire. The test hasn’t been validated for use by emergency physicians.
The HINTS exam comprises three parts:
- Head Impulse Test
- Nystagmus
- test of Skew.
The examination begins with testing for nystagmus. If absent, the rest of the HITS components of the exam cannot be performed.
The results are as follows:
-
The presence of concerning nystagmus (any nystagmus that is not purely unidirectional), bilaterally normal Head Impulse test and the presence of Skew indicates a central cause for the nystagmus, which may indicate a posterior circulation stroke.
-
If the nystagmus is direction-fixed, there is no skew deviation, and there is an abnormal Head Impulse Test with a corrective saccade, this suggests of peripheral aetiology such as vestibular neuritis.
The Study
Nolan K et al. Improper performance of HINTS exam in emergency physicians is driven by incorrect use of nystagmus. AJEM 2025, 94:185-187.
This study aimed to look at how accurately Emergency Physicians selected patients for the HINTS Exam.
