Test to help identify central strokes in patients presenting with continuous vertigo.
Head Impulse: head thrust from 20-30 degrees lateral towards midline while patient maintains gaze on eyes
Nystagmus:
Test of Skew: cover one eye and quickly uncover to check for ocular re-alignment.
If any of the above tests suggest central etiology in the setting of continuous and active vertigo, MRI or neurology consultation should occur.
HINTS exam sensitivity may be 100%, and may be more sensitive than MRI in the first 48 hrs of symptoms.
! In patients without continuous and active vertigo, the head impulse test and test of skew will suggest a central etiology because the VOR is, at the time of testing, intact.
Kattah JC et al. HiNTS to diagnose Stroke in Acute Vestibular Syndrome. Stroke. 2009. 40(11): 3504-3510.