The HINTS exam is a three-part, rapid beside oculomotor test used to help differentiate central from peripheral vertigo. HINTS stands for Head Impulse, Nystagmus and Test of Skew.
The test consists of three parts:
1 – Patients with peripheral vertigo will have abnormal (positive) head impulse testing, while patients with central vertigo typically have a normal (negative) head impulse test.
2 – Patients with peripheral vertigo will have unidirectional, horizontal nystagmus, while patients with central vertigo can have rotatory or vertical nystagmus, or direction-changing horizontal nystagmus.
3 – Alternate eye cover testing may reveal skew deviation in patients with central vertigo, and should be absent in peripheral vertigo.
Head Impulse Test
Direction Changing Nystagmus
Abnormal Test of Skew
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