症例 challenge · Neurology / Emergency / ENT · teaching

Acute Vertigo (HINTS) — Management Pathway · case challenge

Given a case, work through the care pathway step by step; the tool checks each choice and scores you. Decisions and basis are taken from this site's reviewed care pathways.

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Case #1Neurology / Emergency / ENT

📋 Case data

Does HINTS suggest central?All three peripheral

Data is taken from this pathway's reviewed node text. Work through the pathway step by step.

Step 1 / 1 · Does HINTS suggest central?

Persistent acute vestibular syndrome (AVS) — does HINTS suggest central?

💡 AVS = persistent vertigo (>24 h) + nausea/vomiting + nystagmus + gait instability, ~25% are posterior-circulation stroke. HINTS is only for persistent AVS, not BPPV (positional/episodic). Three steps: 1) head impulse test normal = central (counterintuitive), corrective saccade = peripheral; 2) nystagmus direction-changing/vertical = central, unidirectional horizontal = peripheral; 3) skew deviation (alternate cover) present = central. Central mnemonic INFARCT. HINTS-Plus: new unilateral hearing loss = central. Requires a trained examiner.

For teaching. Decisions and their basis are taken from this site's reviewed care pathways; for licensed clinicians/trainees, this does not replace clinical judgment or local protocols.