HINTS for Stroke in Acute Vestibular Syndrome
Identifies potential stroke in patients with acute vestibular syndrome (AVS).
Proper administration of the test itself is critical to using this calculator. See a video from the authors here.
-
A “benign” HINTS examination, in the absence of other neurological deficits, suggests a peripheral localization, and investigation and management can be directed at this possibility.
-
A “dangerous” HINTs examination strongly supports a central lesion, and appropriate workup is required.
-
An important exception is that acute ischemia of the anterior inferior cerebellar artery territory can produce a “benign” HINTS examination. This possibility should be considered in patients with vascular risk factors, sudden-onset symptoms, or concurrent ipsilateral hearing loss.
-
Consider neurologist, neuro-ophthalmologist, or neuro-otologist consultation in the disposition of AVS patients, as even if the HINTS examination is “benign,” many peripheral lesions are amenable to time-sensitive therapy (eg. vestibular neuronitis).
-
Vestibular suppressants, such as prochlorperazine, can impede recovery and compensation of a peripheral vestibular lesion, and thus should be very rarely and sparingly used (if at all).
-
Patients with a “dangerous” HINTS examination are generally admitted for neuroimaging and appropriate directed therapies (e.g. stroke).
HINTS does not replace a detailed history and general neurological examination, and care must be taken not to ignore other non-vestibular diagnoses (e.g. the vertiginous aura of superior temporal lobe seizures).