What does HINT stand for?

HINT stands for Head-Impulse, Nystagmus, Test-of-Skew — the three bedside components of the exam. Some sources call it HINTS (with a trailing S for "plus" or "stroke"), but the core three steps are the same.

Which HINT pattern suggests stroke?

Any single "central" finding raises concern: (1) a normal head-impulse test (no corrective saccade), (2) direction-changing nystagmus (beats left on left gaze, right on right gaze), or (3) skew deviation (vertical refixation on cover-uncover). Even one central sign warrants urgent neuroimaging.

Is HINT better than an MRI scan?

In the first 24–48 hours after symptom onset, early diffusion-weighted MRI can miss up to 20% of posterior fossa strokes. A correctly performed HINT exam by an experienced clinician has been shown to be more sensitive than early MRI in this window. MRI remains essential for full evaluation but should not be used alone to exclude stroke.

Does HINT apply to positional vertigo (BPPV)?

No. HINT is designed for acute, spontaneous, continuous vertigo — not vertigo that only occurs with head position changes. Classic BPPV triggered by the Dix-Hallpike maneuver is evaluated separately.

What if the head-impulse test is equivocal?

Treat an equivocal head-impulse test as normal (central pattern) until proven otherwise. The HINT exam is most reliable when the clinician has training in the maneuvers; an uncertain HIT should increase, not decrease, concern for stroke.

Does this tool store patient data?

No. All processing happens in your browser. No patient information is transmitted or stored anywhere.

HINT Vertigo Helper

Walk through the 3-step HINT bedside exam and get an evidence-based interpretation: BPPV-pattern or stroke-pattern.

Interpretation

Complete all three steps and press Interpret to see the result.

Step	Finding	Signal

For clinical decision support only. HINT exam accuracy depends on examiner training. Always combine with full history, neurological exam, and specialist judgment. A negative HINT does not exclude all central causes.

Summary

Walk through the 3-step HINT bedside exam and get an evidence-based interpretation: BPPV-pattern or stroke-pattern.

How it works

Select the patient presentation: this tool applies only to acute, continuous (not positional) vertigo or dizziness.
Perform the Head-Impulse Test: rapidly rotate the head 10–20° toward one side and watch for a corrective saccade.
Observe nystagmus direction: check whether nystagmus is unidirectional (beats one way in all gaze positions) or direction-changing (switches direction with lateral gaze).
Perform the Test-of-Skew: cover and uncover each eye and watch for a vertical refixation movement (skew deviation).
Enter each finding and the tool applies HINT interpretation logic to classify the pattern.
A BPPV-pattern result (abnormal HIT + unidirectional nystagmus + no skew) supports a peripheral cause; any other combination raises concern for central pathology.

Use cases

Emergency physicians evaluating acute-onset continuous vertigo.
Neurologists screening for posterior fossa stroke at the bedside.
Residents and students learning the HINT exam sequence.
Rapid triage to determine urgency of MRI/CT angiography.
Teaching tool for distinguishing peripheral vs. central vertigo.
Documentation aid to record HINT findings systematically.

HINT Vertigo Helper

0 Patient Presentation

H Head-Impulse Test (HIT)

N Nystagmus Direction

T Test-of-Skew (Alternate Cover Test)