hints_exam_score: HINTS Exam for Acute Vestibular Syndrome

In cliot: Clinical Indices and Outcomes Tools

HINTS Exam for Acute Vestibular Syndrome

Description

Interprets the HINTS exam (Head Impulse, Nystagmus, Test of Skew) to distinguish between central causes (e.g., stroke) and peripheral causes (e.g., vestibular neuritis) of acute vestibular syndrome. The presence of ANY central sign ("INFARCT" pattern) suggests a central etiology with higher sensitivity than early MRI for posterior fossa stroke.

Usage

hints_exam_score(head_impulse_normal, nystagmus_direction_changing,
                 skew_deviation_present)

Arguments

head_impulse_normal	Numeric (0 or 1). Result of the Head Impulse Test. 1: Normal (No corrective saccade). This is a CENTRAL sign (Worrisome). 0: Abnormal (Corrective saccade present). This is a PERIPHERAL sign (Reassuring).
nystagmus_direction_changing	Numeric (0 or 1). Characteristics of spontaneous nystagmus. 1: Direction-changing (gaze-evoked bidirectional). This is a CENTRAL sign. 0: Direction-fixed (unidirectional). This is a PERIPHERAL sign.
skew_deviation_present	Numeric (0 or 1). Test of Skew (Cover-Uncover Test). 1: Skew deviation present (vertical refixation). This is a CENTRAL sign. 0: No skew deviation. This is a PERIPHERAL sign.

Value

A list containing:

HINTS_Result	Clinical interpretation (Central vs. Peripheral).
Recommendation	Suggested next steps (MRI vs. Supportive care).
Central_Features_Present	List of specific alarming findings identified.

References

Kattah JC, Talkad AV, Wang DZ, Hsieh YH, Newman-Toker DE. HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging. Stroke. 2009;40(11):3504-3510. doi:10.1161/STROKEAHA.109.551234

Examples

# Example 1: Stroke Likely (INFARCT)
# Head Impulse Normal (1), Nystagmus Direction-Changing (1), No Skew (0)
hints_exam_score(1, 1, 0)

# Example 2: Peripheral Vestibulopathy
# Head Impulse Abnormal (0), Nystagmus Fixed (0), No Skew (0)
hints_exam_score(0, 0, 0)

cliot documentation built on Dec. 1, 2025, 1:06 a.m.