The HINTS Exam (Head Impulse Test, Nystagmus, Test of Skew) скачать в хорошем качестве

The HINTS Exam (Head Impulse Test, Nystagmus, Test of Skew)

The HINTS Examination (Head Impulse Test or, Head Thrust Test, Nystagmus, Test of Skew) Following the initial description of HINTS to diagnose acute vestibular syndrome (AVS) in 2009, there has been significant interest in the systematic evaluation of HINTs to diagnose stroke and other less common central causes of AVS. This trend increased with availability of the video head impulse test (video-HIT). This article reviews the original papers and discusses the main publications from 2009 to 2017. Many authors use video-HIT in the diagnosis of patients with AVS; this paper focuses on the major publications on the topic featuring nystagmus, manual and video-HIT, and skew deviation. Twenty-five papers provide a summary of the last 8 years’ application of HINTS, the video-HIT added quantitative information to the early clinical observations. Further research will undoubtedly provide specific combination of abnormalities with high degree of lesion localisation and aetiology. In a short time following the original description, neurotologist and neurologists in the evaluation of AVS use the HINTS triad. The introduction of the video-HIT added greater understanding of the complex interaction between the primary vestibular afferents, brainstem and cerebellum. In addition, it permits evaluation of the angular vestibulo-ocular reflex in the plane of all six semicircular canals, with accurate peripheral versus central lesion localisation often corroborated by brain imaging. The triad of h-HIT, horizontal, direction changing nystagmus and skew deviation compared with the results of MRI performed within 48 hours after symptom onset revealed that the combined value of the three ocular motor tests; provided greater sensitivity (100%) and specificity (96%). In the first submission, the title of the manuscript was ‘Subtle Eye Signs in AVS differentiate central from peripheral vestibular lesions,’ however, one manuscript reviewer suggested a change in the title, and David Newman-Toker, M.D., PhD then coined the acronym: ‘HINTS’, widely used since then. The acronym refers to HI: Head Impulse, N: Nystagmus direction and TS: Testing Skew. In addition, a second acronym and mnemonic: INFARCT summarises the application of HINTS: IN: Impulse normal, FA: Fast Alternates (referring to the nystagmus fast phase) and RCT: Refixation on cover test (skew deviation) Reference: Kattah JC. Use of HINTS in the acute vestibular syndrome. An Overview. Stroke Vasc Neurol. 2018;3(4):190-196. Published 2018 Jun 23. doi:10.1136/svn-2018-000160 Smith T, Rider J, Cen S, et al. Vestibular Neuronitis (Labyrinthitis) [Updated 2019 Dec 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NB... Nelson, James & Viirre, Erik. (2009). The Clinical Differentiation of Cerebellar Infarction from Common Vertigo Syndromes. The western journal of emergency medicine. 10. 273-7. NICE (May 2019). Suspected neurological conditions: recognition and referral: http://www.nice.org.uk/ https://www.rcemlearning.co.uk/refere... https://wikem.org/wiki/EBQ:HINTS_Exam https://gpnotebook.com/simplepage.cfm... Image credit: Kjpargeter, katemangostar, master1305 / Freepik @ http://www.freepik.com https://vectorstate.com/imagedetails/... Determining whether vertigo is of peripheral or central origin is critical. Taking a detailed history regarding the onset, tempo, prior episodes, associated symptoms and relevant risk factors is the first step in determining the aetiology. In combination with a good history, the HINTS examination is a useful tool in detecting acute, time-sensitive, central causes of vertigo, including posterior circulation strokes like lateral medullary syndrome. While most vertebrobasilar strokes are also accompanied by other signs (such as diplopia, dysarthria, dysphagia, motor and sensory deficits) a proportion of cerebellar strokes present only with vertigo and subtle incoordination on examination. A positive HINTS exam has been reported to have a high sensitivity and specificity for the presence of a central cause of vertigo.