Using HINTS in acute vestibular syndrome: A practical guide for the acute care physician

Acute vestibular syndrome (AVS) is a common clinical presentation. Common causes include peripheral, self-limiting labyrinthine disorders, but a significant proportion are caused by posterior circulation stroke (PoCS). Delineating between a peripheral versus central cause in AVS is challenging for acute care physicians, but a simple, three-step bedside test known collectively as the HINTS examination may be useful. Substantial evidence supports the use of the HINTS examination in detection of PoCS in AVS, but it is important that performer is trained and experienced to ensure reliability of the test's results. There is some evidence that video-assisted HINTS examination may help to improve HINTS performance, but further research is needed. This review is a practical guide for acute care physicians in regards to when to perform the HINTS examination, how to interpret its findings, limitations and practical considerations.