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On HINTS testing, the patient with acute peripheral vestibulopathy, as in acute viral labyrinthitis, has an abnormal HIT, showing a corrective saccade, unidirectional nystagmus and no skew deviation. The patient with acute vertigo due to a brainstem stroke or other structural pathology has a normal HIT, with no corrective saccade, direction changing nystagmus and may have skew deviation. A central finding on any of the three tests suggests a central lesion. The pattern of findings on HINTS testing can thus help distinguish an acute peripheral vestibular disturbance from acute structural pathology of the posterior fossa.
MRI is sometimes normal in acute brainstem stroke. In a study of 190 patients with acute vertigo, HINTS substantially outperformed ABCD2 for stroke diagnosis in the ED and also outperformed MRI obtained within the first 2 days after symptom onset. For any central lesion, sensitivity was 96.8%, specificity was 98.5%, LR+ was 63.9, and LR- was 0.03. Initial MRIs were falsely negative in 14.3% of acute infarctions. (3) HINTS can identify acute strokes more accurately than even MRI-DWI. (4). In a study of 91 patients with acute vertigo, HINTS had a sensitivity of 88% and a specificity of 96%. (5) In another study of 114 patients, HINTS had a sensitivity of 100% and a specificity of 94.4%. (6)
[https://collections.lib.utah.edu/details?id=1209722 Gold and Tourkevich ] created a demonstration and discussion of the HINTS for the Neuro-Ophthalmology Virtual Education Library at the University of Utah.
