HINTS Atlas

An interactive teaching atlas of the Head Impulse, Nystagmus, and Test of Skew exam — the bedside three-step protocol that distinguishes peripheral from central causes of acute vestibular syndrome.

HINTS is a bedside protocol for patients presenting with the acute vestibular syndrome — sudden, persistent vertigo lasting hours to days with nystagmus, head-motion intolerance, gait unsteadiness, and nausea. Used appropriately, it out-performs early MRI diffusion-weighted imaging for detecting posterior circulation stroke in the first 24–48 hours.

This atlas walks through the underlying anatomy, the recording and bedside technique, normal and abnormal patterns, and the HINTS signature of each major disease. Interactive simulators, clinical cases, a pattern-recognition trainer, and a self-assessment quiz let you practise as you learn.

Core modules

Introduction

What the HINTS exam is, when to use it, and why it out-performs early MRI for posterior circulation stroke in acute vestibular syndrome.

Anatomy & physiology of the VOR

Semicircular canals, otoliths, vestibular nerve divisions, brainstem nuclei, cerebellar circuits, and the three-neuron vestibulo-ocular reflex.

Examination technique

How to perform each component of HINTS at the bedside, with positioning, instruction, and common pitfalls.

Normal findings

What a normal head impulse, normal nystagmus pattern, and absent skew look like — both at the bedside and on quantitative recording.

Disease patterns

Vestibular neuritis

The archetypal peripheral cause of acute vestibular syndrome. Classic reassuring HINTS triad.

Posterior circulation stroke

AICA, PICA, and cerebellar territory infarcts. Central HINTS pattern. The INFARCT mnemonic.

Vestibular migraine

Episodic vertigo with migraine features. Why HINTS is not validated outside acute vestibular syndrome.

MS & brainstem demyelination

Internuclear ophthalmoplegia, vertical nystagmus, and central HINTS features in demyelinating disease.

Ménière's disease

Episodic vertigo with fluctuating low-frequency hearing loss, tinnitus, and aural fullness. Peripheral HINTS during the attack.

BPPV

Brief positional vertigo from displaced otoconia. Why HINTS is not the right tool — use Dix-Hallpike and canalith repositioning instead.

Tools

Clinical cases

Hand-authored cases with synthesised traces and single-best-answer questions.

HINTS trainer

Infinite random cases; tick the findings you observe, then reveal graded feedback.

Compare

Side-by-side traces from any two disease signatures or normal references.

Self-assessment

Browse, spaced-review, and timed modes across foundation to clinician level.

Glossary

60–80 terms with aliases, see-also cross-links, and bookmarking.

References

Peer-reviewed citations and acknowledgements.