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the HINTS exam


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



The EMJClub Emergency Medicine Podcast: The HINTS exam in Vertigo


Scott Weingart: EMCrit Podcast 33 – Diagnosis of Posterior Stroke




Want to read more…?


HINTS to diagnose stroke in the acute vestibular syndrome: Three-step bedside oculomotor exam more sensitive than early MRI diffusion-weighted imaging


Does my dizzy patient have a stroke? A systematic review of bedside diagnosis in acute vestibular syndrome


The Clinical Differentiation of Cerebellar Infarction from Common Vertigo Syndromes



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