1/9 Team! 1st #MedEd #tweetorial. Inspired by our new Resident led Physical Exam Rounds @UNCDeptMedicine .I will focus on the HINTS exam. Twitter community I am open to your thoughts and would love to learn how you perform or interpret the HINTS exam. @AndreMansoor @NateWarnerMD
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2/9 It is said that Julius Cesar was plagued with divine intervention as he would get bouts of limb weakness, dizzy spells and headaches. Occasionally attributed to epilepsy and many other illnesses however I wonder if he had a central lesion that could explain it all.
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3/9 Acute vestibular syndrome is characterized by acute onset vertigo accompanied by nausea, emesis, nystagmus and unsteady gait. Majority due to vestibulopathy however close to 1/4 can be d/t cerebellar or brainstem lesions. HINTS exam may help distinguish peripheral vs central.
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4/9 H.I.N.T.S stands for: Head Impulse, Nystagmus and Test of Skew.
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5/9 Head Impulse: This test relies on a proper functioning vestibulo-ocular reflex. Normal allows you to focus on objects in front as you rotate your head briskly. If peripheral vestibular disease is present corrective saccades will present. Which is not seen in central lesions.
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6/9 Bidirectional or changing Nystagmus: Both central and peripheral pathologies will lead to rapid beating nystagmus in the direction of the lesion. Central causes of nystagmus will increase rate bidirectionally
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7/9 Test of Skew: In patients with cerebellar or brainstem lesions a deconjugate gaze can be appreciated with cross cover testing due to the interruption of the sensory signals to cranial nerve III, IV, VI.
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8/9 A H.I.N.T.S exam concerning for a central lesion will manifest with +1 of the following: normal head impulse test, bidirectional or changing nystagmus and a positive test of skew. All 3+signs: +LR 10.8. Absence of 3 signs: -LR 0.02.
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9/9 McGee, S. R. (2018). Evidence-based physical diagnosis Journal of Neuro-Ophthalmology. 2018; 38(2), 244–250. Andrews, E. Retrieved from http://History.com/news/Julius-caesar … Arch Neurol. 1988;45(7):737–739.
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great tweetorial- for those of us who have difficulty remembering this we’ve collected some short visuals to help learners recall what they’re looking for: “HINTS physicalexam” ->https://www.grepmed.com/?q=hints+physicalexam …
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