What are the components of the HiNTs exam used for assessing vertigo?

The HiNTs exam is a clinical tool specifically designed for the evaluation of patients presenting with vertigo. It helps differentiate between central and peripheral causes of vertigo, particularly when patients present with dizziness that could be due to vestibular disorders.

The components of the HiNTs examination include the Head Impulse Test, assessment of nystagmus, and the Test of Skew.

The Head Impulse Test evaluates the function of the vestibulo-ocular reflex (VOR). During this test, the physician rapidly turns the patient's head while the patient is instructed to fixate on a target. A normal response indicates a functioning VOR, suggesting that the peripheral vestibular system is intact. An abnormal response may indicate a vestibular pathology.

Nystagmus refers to involuntary eye movements, and its characteristics (such as direction, presence of gaze-evoked nystagmus vs. spontaneous nystagmus) can provide critical clues regarding the underlying cause of vertigo. For instance, certain types of nystagmus can suggest a central nervous system issue, while others may indicate peripheral causes.

The Test of Skew measures ocular alignment and can help identify vertical misalignment of the eyes, which is indicative of a central lesion if