EM Vivas · Vertigo and dizziness
HINTS and the dangerous dizzy patient
Viva on bedside vestibular assessment.
On this page
Study tools
Target exams
ACEMFRCEMABEM
Prompt
A patient has continuous vertigo for 18 hours. Explain when HINTS is valid, what constitutes a central pattern, why early CT is insufficient, and how BPPV management differs.
Interpretation
Reveal interpretationShowHide
HINTS applies to continuous acute vestibular syndrome, not brief positional spells. Central pattern: normal head impulse (no catch-up saccade), direction-changing nystagmus, skew deviation — "INFARCT" mnemonic components.[1] Early CT misses most posterior circulation infarcts; MRI if available and neurology pathway. BPPV is brief positional; diagnose with Dix-Hallpike and treat with Epley — do not label all dizziness BPPV.
References1ShowHide
- [1]Kattah JC, et al. HINTS to diagnose stroke in acute vestibular syndrome. Stroke, 2009.PMID 19762709