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Updated: Dec 11, 2025

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Dizziness and Vertigo: The Skillful Examination.

Ari A Shemesh1, Daniel R Gold

  • 1Department of Neurology (AAS, DRG), the Johns Hopkins University School of Medicine, Baltimore, Maryland; and Departments of Ophthalmology (DRG), Otolaryngology-Head and Neck Surgery, Neurosurgery and Emergency Medicine, the Johns Hopkins University School of Medicine, Baltimore, Maryland.

Journal of Neuro-Ophthalmology : the Official Journal of the North American Neuro-Ophthalmology Society
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Summary
This summary is machine-generated.

A targeted clinical examination for dizziness and vertigo, such as the HINTS/HINTS "Plus" exam, helps clinicians quickly determine if acute isolated vestibular syndrome is caused by a stroke.

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Area of Science:

  • Neuroscience
  • Ophthalmology
  • Otolaryngology

Background:

  • The visual, ocular motor, and vestibular systems are closely interconnected anatomically and neurally.
  • This intricate relationship necessitates a comprehensive assessment approach for patients presenting with dizziness and vertigo.

Purpose of the Study:

  • To highlight the importance of a systematic clinical examination in diagnosing dizziness and vertigo.
  • To emphasize the utility of the HINTS/HINTS "Plus" examination in evaluating acute isolated vestibular syndrome.

Main Methods:

  • A methodical approach to patient examination.
  • Targeted clinical examination including HINTS/HINTS "Plus" to differentiate stroke from other causes.

Main Results:

  • The HINTS/HINTS "Plus" examination allows clinicians to bedside probe the critical "stroke" hypothesis in acute isolated vestibular syndrome.
  • A systematic approach facilitates lesion localization and diagnosis.

Conclusions:

  • A structured examination is feasible for assessing patients with dizziness and vertigo.
  • This approach aids in accurate diagnosis, lesion localization, and management planning.