Sudden-onset, constant vertigo with nausea/vomiting, gait unsteadiness, and spontaneous nystagmus define acute vestibular syndrome (AVS). This Figure details the Head-Impulse-Nystagmus-Test-of-Skew (HINTS) exam, which uses special maneuvers to identify central etiologies of AVS with greater sensitivity than hyperacute MRI.1,2 The presence of unidirectional nystagmus (especially when following Alexander's law) and catch-up saccades following a lateral head impulse (from difficulty maintaining target fixation) both typically imply peripheral pathology.1 Vertical ocular misalignment (skew deviation) on cross-cover testing is always suspicious for central pathology.1 Central pathology cannot be excluded if any individual finding is inconsistent with peripheral localization.1
Figure. Hints to the H.I.N.T.S. Exam for Acute Vestibular Syndrome.
Author Contributions
H.W. Sutherland: drafting/revision of the manuscript for content, including medical writing for content; study concept or design. C. Gummerson: drafting/revision of the manuscript for content, including medical writing for content; study concept or design.
Study Funding
No targeted funding.
Disclosure
The authors report no disclosures. Go to Neurology.org/NE for full disclosures.
References
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