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HINTS in the Acute Vestibular Syndrome: Pearls and Pitfalls

Kung, Nathan, H., MD; Van Stavern, Gregory, P., MD; Gold, Daniel, R., DO

Journal of Neuro-Ophthalmology: June 2018 - Volume 38 - Issue 2 - p 244–250
doi: 10.1097/WNO.0000000000000608
The Clinical Examination

Abstract: The acute vestibular syndrome (AVS) is characterized by the rapid onset of vertigo, nausea/vomiting, nystagmus, unsteady gait, and head motion intolerance lasting more than 24 hours. We present 4 patients with AVS to illustrate the pearls and pitfalls of the Head Impulse, Nystagmus, Test of Skew (HINTS) examination.

Department of Ophthalmology and Visual Sciences (NHK), Department of Ophthalmology and Visual Sciences (GPVS), and Department of Neurology (GPVS), Washington University School of Medicine, St. Louis, Missouri; and Departments of Neurology (DRG), Ophthalmology, Neurosurgery, and Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland.

Address correspondence to Daniel R. Gold, DO, Division of Neuro-Visual and Vestibular Disorders, Departments of Neurology, Ophthalmology, Neurosurgery, Otolaryngology-Head and Neck Surgery, The Johns Hopkins Hospital, 600 N Wolfe Street, Pathology 2-210, Baltimore, MD 21287; E-mail:

G. P. Van Stavern: Research was supported by DOVS Core Grant 5 P30 EY02687, Institute for Clinical and Translational Sciences Grant RR023496, Biostat Core Grant U54 RR023496, an unrestricted grant from Research to Prevent Blindness, and NIH Core Vision Grant P30 EY02687. D. R. Gold: Research was supported by Department of Defense MR141166.

The authors report no conflicts of interest.

© 2018 by North American Neuro-Ophthalmology Society