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{{JC info
| title= HINTS to Diagnose Stroke in the Acute Vestibular Syndrome: Three-Step Bedside Oculomotor Examination More Sensitive Than Early MRI Diffusion-Weighted Imaging
| abbreviation= HINTS
| expansion=
| published= 2009
| author= Kattah, J. et al
| journal= Stroke
| year= 2009
| volume= 40
| issue=11
| pages= 3504–3510
| pmid= 19762709
| fulltexturl= http://stroke.ahajournals.org/content/40/11/3504.long
| pdfurl=http://stroke.ahajournals.org/content/40/11/3504.full.pdf
| status = Complete
}}

==Clinical Question==
Is the HINTS exam (Head-Impulse—Nystagmus—Test-of-Skew) more sensitive for diagnosing stroke than early MRI diffusion-weighted imaging in Acute Vestibular Syndrome?

==Conclusion==
A negative HINTS examination can rule out a stroke better than a negative MRI with DWI in the first 24 to 48 hours after symptom onset with a specificity of 96%.

==Major Points==
{{HINTS Exam Procedure}}

==Inclusion Criteria==
At least one stroke risk factor: 
*[[Atrial fibrillation]]
*[[Diabetes]]
*[[Eclampsia]]
*Hypercoagulable state
*Hyperlipidemia
*Hypertension
*Prior stroke or myocardial infarction.
*Recent cervical trauma
*Smoking

==Exclusion Criteria==
A history of recurrent vertigo with or without auditory symptoms

==Interventions==
Patients presenting with symptoms of acute vestibular syndrome underwent neurological and vestibular examination according to a standard protocol:
*head impulse test
*prism cross-cover test for ocular alignment 
*observation of nystagmus in different gaze positions

All patients underwent neuroimaging, generally after bedside evaluation, otherwise the examiner was masked to these results at the time of clinical assessment. 

All patients were admitted for observation and underwent serial daily examinations for evolution of clinical findings.

==Outcome==
 

===Primary Outcomes===
{{HINTS Exam Primary Outcome}}

===Secondary Outcomes=== 
 
 

===Subgroup analysis===

==Further Discussion==
'''This was performed in an outpatient setting by neuro ophthalmologists not emergency physicians and may not be generalizable to an ED population
'''

==Further Reading==
*Newman-Toker et al. HINTS Outperforms ABCD2 to Screen for Stroke in Acute Continuous Vertigo and Dizziness. Academic Emergency Medicine. Volume 20, Issue 10, pages 986–996, October 2013

*Babak et al. Application of the ABCD2 Score to Identify Cerebrovascular Causes of Dizziness in the Emergency Department. Stroke. 2012; 43: 1484-1489

*Perry et al. Prospective validation of the ABCD2 score for patients in the emergency department with transient ischemic attack. CMAJ July 12, 2011 vol. 183 no. 10.

==Funding==
The National Institutes of Health and the Agency for Healthcare Research and Quality

==External Links==
*[http://emcrit.org/misc/posterior-stroke-video/ HINTS Exam Demonstration]
*[http://content.lib.utah.edu/cdm/singleitem/collection/ehsl-dent/id/6 Video on HINTS Exam]
*[https://www.youtube.com/watch?v=VwmrjYuvqtQ&feature=emb_title Another Video on HINTS Exam]

==See Also==
*[[Cerebellar stroke]]
*[[Stroke syndromes]]
*[[Vertigo]]

==References==
<references/>

[[Category:EBQ]]