HINTS Exam for Vertigo Explained - Head Impulse, Nystagmus, Test of Skew - Clinical Skills - Dr Gill
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- เผยแพร่เมื่อ 25 มิ.ย. 2024
- HINTS Exam for Vertigo Explained - Head Impulse, Nystagmus, Test of Skew - Clinical Skills - Dr Gill
TO BE ABSOLUTELY CLEAR - THE HINTS EXAMINATION IS ONLY OF USE IN PATIENTS WITH PROLONGED VERTIGO/NYSTAGMUS/DISEQUILIBRIUM/PRE-SYNCOPE LASTING HOURS TO DAYS
The HINTS test is a time-sensitive examination allowing the clinician to determine whether a patient has a central or peripheral lesion as the cause of their vertigo/dizziness complaint
To boil that down further the HINTS test allows you to quickly determine if vertigo is due to a central (ie possible stroke) or a peripheral lesion
In this video we will go through each part of the HINTS exam:
- Head Impulse,
- Nystagmus,
- Test of Skew
Along with a discussion of the findings
You can find more of Dr Peter Johns videos here:
/ peterjohns
#DrGill #ClinicalSkill #ENT
You can now consult via video or in person with Dr Gill at Dr Finlay’s Private Practice - www.drfinlays.co.uk/services/...
00:00 - Overview of the HINTS Examination
00:54 - Components and Purpose of HINTS Examination
01:28 - Patient Selection for HINTS Examination
02:35 - Distinguishing Between Central and Peripheral Lesions
03:35 - Application of HINTS Examination
06:02 - Reliability of HINTS Examination
06:52 - Common Misuses of HINTS Examination
11:03 - Demonstrating the HINTS Examination Procedure
12:58 - Head Impulse Test
13:41 - Test of Skew
14:44 - Interpreting HINTS Examination Results: HINTS Central vs. HINTS Peripheral
16:17 - Inducing Nystagmus for Educational Purposes :)
17:06 - Conclusion and Final Thoughts
I'm terribly sorry to say that doc, but you should work with better patients, may i suggest one fine lady called Abbie Tutt, born on 7th of December 1996?
ahhahaha goated comment
@@austenblumkaitis9024 explain pls
@@supremebonkripper7460 Abby is a regular "patient" for the exams. For those who watch and follow the channel she is a legend 😁
Still remember Lucy born on 1st of January 1987 😌
Or that 10/10 guy for taking his red shirt off in 0.1 second from years ago. Never other "patient" could reproduce such hability lol
"Patients come to me with vertigo. But thanks to me, their vertigo vertiwent."
🤣🤣 I like that one
😂😂
Didn't go for the obvious "vertigo's vertigone"?
@@evanb8495 damn it.....
I wish mine would vertigo! I was in the Navy for years and NEVER got seasick. Loved it. Finished the Navy, and a year later had my first experience with vertigo, which was extremely confusing because I had no clue what the heck was going on.
I really have no business watching these. I’m a property insurance agent who has literally no exposure to the medical field except yearly checkups, but I LOVE watching your videos. They’re surprisingly soothing, and they help me relax and fall asleep. And on the occasion that I do stay awake throughout the whole thing, I always learn something new, which is really cool. So thank you for the content! I’m looking forward to your next video!!
It’s always interesting the things that we find engaging outside of our normal fields
The little David Bowie flash when he says labyrinthitis is classic
I was hoping people would get the connection 😊
The patient answered the name & DOB question incorrectly but Dr. Gill missed it. The answer he was looking for was “Abbie Tutt, 7th December 1996”
🤣🤣🤣
I don't get it :c
@@amane6397 Abbie is the usual guest star of these videos and her name and DOB are now a classic
I had vertigo a few weeks after having COVID-19 and have spoken to several people with similar symptoms. It was terrifying at the time, and I thought I'd had a stroke :( My amazing GP did a phone consultation as it was during a lockdown. Thank you NHS ❤ And thank you Dr Gill for explaining things so well.
Vertigo is truly one of the most unpleasant, often “not serious” issues I think there is.
Much more so than pain - which can often not have an apparent cause
I had vertigo - only briefly thankfully - it really feels like your body is betraying you
@@DrJamesGillI got it after a plan ride when I was twelve and it scared me so much
This man is the bob ross of the medical field, both career paths I have no business watching but I can’t turn it off!!
I burst out at laughing at the sudden Labyrinth reference.
👍👍 SUCCESS!!!
Spontaneous Nystagmus sounds like a spell xD I can totally imagine Hermione correcting my pronunciation.
🤣🤣
"It's SponTANeous NysTAGmus, not SpontaNEOUS NYStagmus!"
Showing people with the symptoms is such a good addition.
Difficult to get that footage though
Hey Dr Gill,
I'm a Menieres patient, also living with diabetes. My first symptoms of Menieres began in a hotel room. During the day I felt mild vertigo which became more severe by late night. I was very seasick (in a 10 story building on solid ground) and experienced everything that occurs with severe seasickness 🤢
No doctor ever suspected Menieres until 4 years later. By that time the hearing loss on my right side was very noticeable, but the vertigo was gone.
Two years after that, I experienced a very rapid onset of vertigo while I was driving. Luckily I managed to not crash. Two weeks after that episode, my gp did a full blood work up and discovered my glucose levels were 380 mg/dl. The next day at the follow up, a finger stick showed my glucose was 476. So likely that severe, rapid onset of vertigo was due to very high blood glucose, and not a return of the Menieres symptoms. (My hbA1c was 14%)
Now I keep my glucose under control, A1c between 6.8 and 7.4 usually. The vertigo has never returned. But from the Menieres, my hearing loss is permanent on the right side and I must live with that constant ringing noise. The hearing on my left side is normal.
This is a useful, if horrible example of why diabetes is so serious.
I’m sorry you’ve been though this, although I’m glad you’ve not had further issues with the vertigo
Your student in the demonstration looks so sad like a kid that just got put in time out lol aw
Omg! I have Menieres! It’s cool to learn about all these tests for it. The tests they had me do were super different, and more similar to inebriation balance tests! They did take lots of videos of my eyes before and after different activities though lol
Menieres is annoying as it’s so difficult to treat
My favorite doctor.
👍
I burst awake with vertigo in May 2020, thinking I was having a stroke. They told me I had BPPV, but it has never gone away completely and I have to use a cane most days due to spinning and pain in my head and ear. Some days are good but the pain never goes away and the dizziness is mild but not gone. I am glad there are tests like this to help people figure things out. It's so scary to live with. Almost crippling. Thank you for posting these :)
That’s a little unusual. Did you get a referral to ENT?
@@DrJamesGill I did from my doc in the hospital, but 8 months later they said they were too busy and couldn't see me. My family doctor has been great and advocated for me to a new ENT and the waiting period is another 8-9 months, which is in March, so here is hoping :)
Loved the Labyrinth Bowie appearance!
👍
Doc un saludo desde argentina!
Top notch video. Thanks doc.
👍
Keep it up Gill
We’re trying 😊
I had labyrinthitis in 2020 after I caught COVID, it went on for about a year (six month of intense motion sickness) followed by lesser bouts. I still get it two years later but very minor! to those recovering it does get better !
It really astonishes me at time the breadth of problems covid has caused.
Glad things have improved somewhat for you though 😊
The audio is extra crispy. I like it.
I love these blogs! Dr Gill is cute also!
I suffer with Vertigo so really looking forward to this! 😵💫
Hopefully it helped you understand one of the tests you may have seen
Perhaps we should do a video looking at WHAT vertigo actually is?
@@DrJamesGill that would be really helpful for us spinners, especially to understand how the heck you wake up with it and if there are triggers I'm completely unaware of. Such random unpredictable occurrences but when it hits ... boy oh boy i feel like the titanic in a vortex.
Thank you ..watching from the Philippines
Thanks for watching!
@Dr. James Gill..it is very informative..i will share it here in Philippines
Omg your the best doc ever I learned so much from you I'm going to medical school thx you doctor gill your the best
Wonderful to hear!! Where are you going?
@@DrJamesGill I'm going to Warwick medical school and I want to to be just as a good doctor as you are I'm actually 16 but I'm practicing now so I can get better
Amazing explanation, thank you for explaining hints exam, I am studying vertigo examination for my weekly exam in ENT and I believe it is going to be pretty helpful for not just now but for my next years in medical field.
It’s a challenging one to get into your head - well at least it was for me. But it think once you understand HOW to use it, it’s much easier
Dr! When first out break of Covid hit i had to find something. I found you! For this i thank you. You have been and truthfully are being a saving grace.
Welcome! Hope it’s useful
I get vertigo and nystagmus as part of migraine prodrome and it's a very good prompt to go have a lie down... But as you've said elsewhere, one of the worst non-pain symptoms.
Unpleasant. But as you say, it does work well as an alert
16:26 me sitting and thinking about regrets in life
unintentional ASMR
You're poor student/patient looks like he's afraid he is about to receive some bad news
I think he was just bored 🤣
Bonus points for the Bowie reference.
👍
Hi Dr Gill,
I love watching your videos even though I’m going down a different medical field branch (I’m currently in my undergrad in a Pre-occupational therapy concentration) and I noticed a lot of this exam requires looking directly into the examiner’s eyes. I was just wondering what you might do if you were working with someone on the spectrum as I’ve heard sometimes someone who is on the spectrum finds it almost physically painful to look people in the eyes. What sort of alternatives might there be?
You explain the need and what you are looking for
As you say, looking into someone’s eyes can be very uncomfortable. There are MANY tests - blood taking as just a simple example - that are uncomfortable, but as long as people understand the need, are happy to undertake
It’s all about communication
@@DrJamesGill fair enough thank you for the response 🙏
This video is nothing short of exceptional. I don’t think I’ve seen another video that detailed why the hints shouldn’t be performed in certain patient groups.
Have you sorted your Audio now? I did see a video where you had a lav mic on but still seemed to have a large amount of hiss .
Check out the zoom f2 recorder.
His changing of cameras causes Vertigo too. Also watch music video retrovertigo.
Watching from Ottawa, different Ottawa! But named after the same prairie tribe that got run up to Canada.
Great video! I like this format of video a lot but I do have an unrelated question, are you planning on making more "a to z of the NHS"?
Thanks, we will be, just things have been a little busy of late 😊
your voice is so soothing lol
Thanks for the info. I have suffered with this since a young child, I would wake up during the night/early hours where I would be so dizzy everything would spin and walking was impossible as I would stumble and fall side to side. If I opened my eyes I would projectile vomit everywhere. It would sometimes lead into a migraine. I had to be left in complete darkness for 2-3 days until it passed and prey I didn’t need to use the toilet. My mum would take me back and forth to our GP but nothing made it better. As an adult I still get this except the migraines are less common and lying flat or moving a certain way can trigger it, symptoms are less intense though I do get pins and needles down one side of my leg when it does happen. Don’t know why 🤷♀️
I also get it randomly when waking up. Absolutely awful. Sometimes when I'm sat in a chair it manifests like i'm falling off the chair sideways and sometimes when i go to bed it kicks up and feels like I've been drinking heavily for days as the headspin is so intense and so painful (I don't drink). absolutely horrific and a lot of people think vertigo is all about heights. Nope! GP just gave me travel sick pills, not so great but also I don't know yet what triggers it, especially when you wake up with it! Weird huh?! I don't get migraines though thankfully.
Very interesting and explanation of utmost precision. Thank you. Do you have any video on allergies and their effects? I have a friend who keeps sneezing and she has always been given paracetamol and Piriton. It has been 3 years now since she has this symptom and took the risk of consuming allercet without prescription. Could you please help. Thank you.
We might be able to deal with allergies sure 😊
Hahah the labyrinth reference 😂
I managed to get monty python into lectures this week!
Love the David Bowie Jareth cameo. :)
Power of the voodoo
Not as powerful as antibiotics though 😜
@@DrJamesGill Unless one overuses them!
I would love to attend whatever medical school Dr Gill offers instruction and education at.
Warwick has application open
They did this when I was diagnosed with vestibular migraines
This is one of the points we discussed - sometimes these can present with features suggestive of stroke, and it’s hugely important to be able to quickly rule it in or out 😊
I had oto-neurological testing done at the hospital a couple years back when my vertigo was horrid - the spinning was just awful.. although i did find out from the audiologist that i had perfect hearing.. ha ha
Great video! Couldn’t directly watch him being spun around in the chair though do to my proprioception issues making me dizzy if I did (thanks sensory processing disorder) so I only half watched from the side while mainly focusing on you, kind of ironic in my opinion though considering the video topic lol…
I have a patients presenting to the ER with Vertigo and Stroke. He said he has prolonged vertigo and his family said he has Nystagmus. How to differentiate if it is central or peripheral? what test to use?
James , where would you go at a point where you experience quite literally every symptom explained in this video (beside an obvious stroke) my mother , age 51 , has been experiencing everything talked about in this video virtually her entire life now. Been to so many clinics to try and identify what the problem is , but to this day there is still no answer , she experiences severe nausea, sickness , vertigo very very often , caused by looking up for more than a few seconds , moving her heard too fast , sleeping on the opposite side , hearing impediment as well , also tinnitus and some occasional nystagma
First port of call would be GP with view to ENT clinic - but it is likely there would need to be a further referral to subspecialist clinic from there too
Jareth popping up properly made me laugh 😂👏🏻
I’m really pleased that several people have got the joke 😊
I like your plant
Audio is so tough to get right! Extra recorders and extra mics can be really helpful if you're doing something complicated and you don't want to have to do it again!
Oh that’s a fact.
I’ve ONE microphone that seems to work, I’ve also bought a Rode Video+ and it ALWAYS just sounds to echoey and just naff
Hi Dr Gill,
This was a very informative video and I thoroughly enjoyed watching!
Just in case you hadn’t noticed, you mistakenly mentioned vestibular neuritis being irritation of CNVII at the beginning of the video (2:43) 😅 nonetheless, this video has informed my clinical practice, so thank you!
Best wishes :)
Drat. Good catch. Unfortunately you can’t add amendments😞
@@DrJamesGill No worries at all! It could be an idea to put the correction in the description box, perhaps?
I had vertigo a couple months back and a chiropractor fixed it immediately. Wondering your thoughts on chiropractors doc
The commonest cause of vertigo is BPPV - so issues with the otoliths in the ear.
This is treated with a series of movements called Epleys. It is likely that they had you do this
2:50, I wasn't ready.
It’s only a flash 😊
@@DrJamesGill Shoot, I thought it was only forever, which incidentally is not long at all.
Jimbo, I want you to be my GP ♥️
Are there circumstances in which it would be appropriate to administer stroke treatment --- due to time pressures --- before you've completed the assessment?
Appreciate the willingness of your student to allow you to put him through that -- not all professors inspire that level of trust.
Unfortunately not, as the treatment for a stroke (clot) would worsen the treatment for a stroke (bleed) as an example
If you suspect a stroke, contact an ambulance straight away.
Thank you doctor for the nice video, but I have a question, what kind of watch is yours?
Garmin Fenix 7
@@DrJamesGill thank you dr
Hello Dr. I wanted to ask u if u can do video regarding lymph nodes. I have a lymph node in right side of my throat close to my thyroid. It started all off after I had covid last year in July 2021. Since then my lump is still there and trouble swallowing. I been for ultrasound in hospital they said is nothing to worry about and should clear off within couple weeks but it's been months now and nothing improved. What could it be? Does it need to be removed or is there anything that can be done about it?
Hello Sir i am an Vestibular Rehab Specialist sir if a patient have unidirectional Nystagmus like left in the above vedio so which semi circular canal is involved and secondly same side Vestibular means left side Is Affected??
Oh I thought this was a video giving hints for an upcoming exam
Unfortunately not
Good video.
By the way, any chance of seeing your 100k subs plaque?
It hasn’t arrived yet! But don’t worry, there is a plan!
I suffer from vertigo or the dizzies as I call them I get it a couple time a month
Oh dear. Your gp might be able to help with that
@@DrJamesGill I am given Antivert. It all started with a virus in my right ear rendering me deaf in it.
Audiologists confirmed that I’m indeed deaf in the right ear but no other help with vertigo other than antivert
I went to the ENT and did all these tests and they said I didn't have bppv but I still have dizziness and they said they didn't have an answer for me for why I still get dizzy, FRUSTRATING!
There are many differentials for dizziness - particularly whilst dizziness Is undefined, may need further discussion with your GP
At 4:18 how do we know that pt didn’t do that deliberately?
I suffered from Vertigo. Then I changed the radio station. (Flicks Vs) Take that, Bono!
🤣
I have suffered from vertigo since 2014 and have had utterly terrifying experiences with it including a vestibular migraine related one.
Would have loved a video like this.
Oh dear. That is horrible. Are you under the care of ENT?
@@DrJamesGill I had the neurology team come round and try figure me out while an inpatient.
They never really figured it out, I did. It was a few things like bad eye strain, new glasses required and migraine, all combined with little sleep.
I still get it if I'm not careful. I have stemetil but I developed a phobia of not getting enough sleep and getting the vertigo, which as you can imagine is not conducive to a normal life.
Great information. Is this serious
It certainly can be, hence the importance of knowing when do you need to do the test
@@DrJamesGill thank you. Will speak to my gp about this
I'm a nurse and sometimes I wish I had your voice. I'm unintentionally loud and I feel bad sometimes. Not always great for bedside manner 🤣
To be fair, I know what you mean - I think my voices changes during the examination as my brain is doing a lot of work here.
During a history, I tend to project more, and people have mentioned they can hear me outside of patients cubicles 😳
I've had vertigo since 2015
Oh dear, what treatment have you had?
@@DrJamesGill I'm currently on Serc(betahistine) tablet. It's has helped a lot still dizzy a little but mostly better except some flare ups
Have tried Stematil and head exercises but no help. I also have small hearing loss and tinnitus
Hello Dr.Gills,
I get motion sickness like symptoms sometimes even when I am not travelling, at first there was ringing in my right ear too and then dizziness and pain in back of head with nausea. What could be the cause and is there any solution to my condition?
Ideally you’d be best placed to talk with your Gp and get examined
When I have vertigo flare up, if someone sat me upright and spun me in a chair, I would project vomit like poltergeist. Never had a doctor put me through this. This would be torture for someone in that condition. Not sure where you learned this doctor.
Let me be very clear - as highlighted in the video - putting Atharvar in the chair is NOT part of the clinical examination, that was to spin the fluid in his middle ear, and generate the movement of his eye, as an example of what can be seen in a vestibular issue
There would be no indication for this in clinic practice
Vertigo and panic attacks.
2:45 Why CN VII and not CN VIII?
Rats - you have caught a error there. It should be CNVIII - vestibulocochlear nerve - to ensure there is no doubt
I have vertigo and it's sucks so bad. Some days it's takes forever to stop others I have to sleep or I'll get sick all day
I’m sorry to hear this. Has it been investigated?
@@DrJamesGill yes my doctor gave me medicine for it to see if it helps.. so far only a little
Dr sorry for that bur your glasses are crooked, left side higher than right side. Greetings from an optician and optometrist ☻
Thank you for that, I’m due to see the optician, and get a check up & new glasses this week 😊
Sir I suffered vertigo last one month ago. some days is normal but someday suddenly dizziness spinning and vomiting.pls guide
You’ll need to speak to your GP
You remind me of the babe, what babe, babe with the power, what power, power of voodoo, who do, you do, remind me of the babe ...
👍
THE GOBLIN KING!
👑
Why do I wish I was this young man!?! lol l
I miss the days when these videos were more examination and less discussion
I’m blind and get extreme vertigo.
Oh dear. I’m so sorry to hear that. When you do get an attach, how to you terminate it?
I thought it was Han Solo 😅😅
Nystagmus predicted this, you know
Har har
2:50 what in the-
Missing Abby already. ☹️
You remind me of the babe..
👍
Vestibular neuritis is not inflammation of cranial nerve 7! It is cranial nerve 8! Get your facts right!
Why are you whispering?
Lost patience , just wanted the facts with no drivelling.
Which particular bits do you mean.
If you need a jump to HOW to do the exam, that is at 11mins
Then I would suggest Google.
Pretty sure the patient is freshly shaven John Oates.
American doctors do none of the myriad of tests you have shown us on your channel. They look at you, as a few questions, tell you you're lying and then charge you 500 bucks.
I’d hope that there is more going on, it may just be that they are using additional information sources
From my point of view, I take a lot of pride with our students, knowing they are able to work clinically without having to rely on imaging etc
- it’s vitally important yes, but good clinical skills will always improve patient care
Sounds like ttpical alcoholism.
The thumbnail is so funny cause it looks like Dr.Gill has his hand ✋ up in his face to disrespect him and the kids looking back at him all scared.
STOP… hammer time 🔨