EBQ:HINTS Exam: Difference between revisions
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==Exclusion Criteria== | ==Exclusion Criteria== | ||
A history of recurrent vertigo with or without auditory symptoms | |||
==Interventions== | ==Interventions== | ||
Revision as of 05:35, 5 January 2014
Under Review Journal Club Article
Kattah, J. et al. "HINTS to Diagnose Stroke in the Acute Vestibular Syndrome: Three-Step Bedside Oculomotor Examination More Sensitive Than Early MRI Diffusion-Weighted Imaging". Stroke. 2009. 40(11):3504–3510.
PubMed Full text PDF
PubMed Full text PDF
Clinical Question
Is the HINTS exam (Head-Impulse—Nystagmus—Test-of-Skew) more sensitive for diagnosing stroke than early MRI diffusion-weighted imaging in Acute Vestibular Syndrome?
Conclusion
A negative HINTS examination can rule out a stroke better than a negative MRI with DWI in the first 24 to 48 hours after symptom onset with a specificity of 96%.
Major Points
- The 3 components of the HINTS exam include: head impulse test of vestibulo-ocular reflex function; observation for nystagmus in primary, right, and left gaze; alternate cover test for skew deviation.
- 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.
- Initial MRIs are falsely negative in 12% and can prove misleading out to 48 hours after symptom onset.
Inclusion Criteria
Exclusion Criteria
A history of recurrent vertigo with or without auditory symptoms