HIT and HINTS

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  1. Neuro-Ophthalmology with Dr. Andrew G. Lee
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Just to clarify, not all patients with a posterior circulation stroke have bidirectional nystagmus. If that were the case, we would only need the "N" or "nystagmus" exam, instead of all three components of the HINTS exam. In a just published study, 25% of posterior circulation strokes had a peripheral (unidirectional horizontal nystagmus) pattern. Nham, B. Capturing vertigo in the emergency room: three tools to double the rate of diagnosis. published online August 16 2021, Journal of Neurology

If any of the three components of the HINT exam are central, (bidirectional nystagmus, normal HIT or vertical skew) then the overall HINTS result is central. I'm sure you know this, but it didn't come across clearly in your video.

Also adding a bedside test of hearing (HINTS plus) increases the sensitivity of HINTS, by picking up AICA strokes where they have a loss of hearing as well as an abnormal HIT.

PeterJohns
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Thank you for the gift featuring hit/hints to an er practitioner. A-Mazing focus.

rodolfozach