Using the HINTS Exam to Diagnose Acute Peripheral Vertigo: A Case Study

Introduction Acute dizziness and vertigo are among the most common reasons for emergency department visits, yet distinguishing between peripheral and central causes remains a clinical challenge. In a recent case study published in the Archives of Case Reports, researchers highlighted the effectiveness of the HINTS exam in diagnosing acute vestibular syndrome. Visit https://www.hspioa.org for more groundbreaking research in this field.

Understanding the Case: A Rare Presentation of Aggressive APV A 39-year-old female presented with a week-long history of disabling vertigo, imbalance, and severe nausea. Despite a prior history of mastoidectomy for cholesteatoma, her tympanic membrane appeared normal, making the diagnosis challenging. However, key clinical findings, including spontaneous nystagmus and an abnormal vestibulo-ocular reflex, pointed toward an aggressive form of acute peripheral vestibulopathy (APV).

Key Findings and Diagnostic Approach

• Clinical Examination: Horizontal spontaneous nystagmus, positive Romberg test, and abnormal head impulse test.
• Imaging: CT scans revealed a large soft tissue density in the right mastoid with significant erosion of the tegmen tympani.
• Surgical Intervention: A modified radical mastoidectomy confirmed extensive cholesteatoma eroding the bony semicircular canal.
• Outcome: Post-operative improvement in vertigo and nystagmus with vestibular rehabilitation.

HINTS Exam: A Critical Tool in Distinguishing Central from Peripheral Vertigo The HINTS exam (Head Impulse, Nystagmus, and Test of Skew) is a simple yet powerful bedside tool with a reported sensitivity of 100% and specificity of 96% in differentiating vestibular neuritis from stroke. According to the American Academy of Neurology (AAN), early recognition of stroke-mimicking conditions like APV is crucial to avoid misdiagnosis and ensure appropriate management.

Strategic Link Placement

• DOI Link: Read the full study at https://dx.doi.org/10.29328/journal.acr.1001011
• Related Research: Explore similar studies on vestibular disorders in our Archives of Case Reports.
• Journal Article: A detailed analysis can be found in our main journal article.

Conclusion & Call-to-Action This case highlights the importance of the HINTS exam in differentiating peripheral from central causes of vertigo, especially in patients with a history of ear surgery. Explore more studies at https://www.hspioa.org and join the conversation by sharing your thoughts in the comments below!

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