Inline citation markers in the chapters link to numbered entries below. Where a Digital Object Identifier is listed, it is the most reliable permanent link to the published paper.

1.
Anburajan G, Kattah J, Wang Z, Mantokoudis G, Newman-Toker DE, Tarnutzer AA (2026). HINTS+ to diagnose AICA stroke: systematic review of the diagnostic impact of acute unilateral hearing loss in the acute vestibular syndrome. J Neurol 273(2):131. doi:10.1007/s00415-026-13641-3
Recent systematic review quantifying the added value of HINTS-plus for AICA-territory strokes.
2.
Halmagyi GM, Curthoys IS (1988). A clinical sign of canal paresis. Arch Neurol 45(7):737-739. doi:10.1001/archneur.1988.00520310043015 · PMID 3390028
Original description of the head impulse test for unilateral horizontal canal paresis.
3.
Kattah JC, Talkad AV, Wang DZ, Hsieh YH, Newman-Toker DE (2009). HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging. Stroke 40(11):3504-3510. doi:10.1161/STROKEAHA.109.551234 · PMID 19762709 · PMC4593511
Original prospective study defining the HINTS protocol. Reported sensitivity for stroke in AVS exceeded early MRI DWI in the validation cohort.
4.
Kim JS, Newman-Toker DE, Kerber KA, Jahn K, Bertholon P, Waterston J, Lee H, Bisdorff A, Strupp M (2022). Vascular vertigo and dizziness: Diagnostic criteria. Consensus document of the Committee for the Classification of Vestibular Disorders of the Bárány Society. J Vestib Res 32(3):205-222. doi:10.3233/VES-210169
Bárány Society consensus criteria for vascular vertigo and dizziness — the framework that situates HINTS within the broader differential.
5.
Lempert T, Olesen J, Furman J, Waterston J, Seemungal B, Carey J, Bisdorff A, Versino M, Evers S, Newman-Toker D (2012). Vestibular migraine: diagnostic criteria. Consensus document of the Bárány Society and the International Headache Society. J Vestib Res 22(4):167-172. doi:10.3233/VES-2012-0453 · PMID 23142830
Bárány / IHS consensus criteria for vestibular migraine — the framework within which HINTS is not the appropriate diagnostic tool.
6.
Lempert T, Olesen J, Furman J, Waterston J, Seemungal B, Carey J, Bisdorff A, Versino M, Evers S, Kheradmand A, Newman-Toker D (2022). Vestibular migraine: Diagnostic criteria (Update). J Vestib Res 32(1):1-6. doi:10.3233/VES-201644 · PMID 34719447
2022 update to the original 2012 vestibular migraine criteria; the criteria themselves are unchanged.
7.
Lopez-Escamez JA, Carey J, Chung WH, Goebel JA, Magnusson M, Mandalà M, Newman-Toker DE, Strupp M, Suzuki M, Trabalzini F, Bisdorff A (2015). Diagnostic criteria for Menière's disease. J Vestib Res 25(1):1-7. doi:10.3233/VES-150549 · PMID 25882471
Bárány Society / Japan Society for Equilibrium Research / EAONO / AAO-HNS / Korean Balance Society joint consensus criteria for definite and probable Ménière's disease.
8.
MacDougall HG, Weber KP, McGarvie LA, Halmagyi GM, Curthoys IS (2009). The video head impulse test: diagnostic accuracy in peripheral vestibulopathy. Neurology 73(14):1134-1141. doi:10.1212/WNL.0b013e3181bacf85 · PMID 19805730
Validation of the video head impulse test (vHIT) against scleral search-coil recordings — the basis for current quantitative VOR gain measurement.
9.
Newman-Toker DE, Kattah JC, Alvernia JE, Wang DZ (2008). Normal head impulse test differentiates acute cerebellar strokes from vestibular neuritis. Neurology 70(24 Pt 2):2378-2385. doi:10.1212/01.wnl.0000314685.01433.0d · PMID 18541870
Demonstrated that a normal bedside head impulse test in acute vestibular syndrome is a central red flag for cerebellar stroke.
10.
Newman-Toker DE, Kerber KA, Hsieh YH, Pula JH, Omron R, Saber Tehrani AS, Mantokoudis G, Hanley DF, Zee DS, Kattah JC (2013). HINTS outperforms ABCD2 to screen for stroke in acute continuous vertigo and dizziness. Acad Emerg Med 20(10):986-996. doi:10.1111/acem.12223 · PMID 24127701
Introduced the HINTS-plus extension — adding new hearing loss by bedside finger rub as a fourth central sign.
11.
Strupp M, Bisdorff A, Furman J, Hornibrook J, Jahn K, Maire R, Newman-Toker D, Magnusson M (2022). Acute unilateral vestibulopathy/vestibular neuritis: Diagnostic criteria. Consensus document of the Committee for the Classification of Vestibular Disorders of the Bárány Society. J Vestib Res 32(5):389-406. doi:10.3233/VES-220201 · PMC9661346
Bárány Society consensus criteria for vestibular neuritis / acute unilateral vestibulopathy.
12.
Thompson AJ, Banwell BL, Barkhof F, Carroll WM, Coetzee T, Comi G, Correale J, Fazekas F, Filippi M, Freedman MS, Fujihara K, Galetta SL, Hartung HP, Kappos L, Lublin FD, Marrie RA, Miller AE, Miller DH, Montalban X, Mowry EM, Sorensen PS, Tintoré M, Traboulsee AL, Trojano M, Uitdehaag BMJ, Vukusic S, Waubant E, Weinshenker BG, Reingold SC, Cohen JA (2018). Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. Lancet Neurol 17(2):162-173. doi:10.1016/S1474-4422(17)30470-2 · PMID 29275977
Current diagnostic framework for MS — referenced on the MS / demyelination page.
13.
von Brevern M, Bertholon P, Brandt T, Fife T, Imai T, Nuti D, Newman-Toker D (2015). Benign paroxysmal positional vertigo: Diagnostic criteria. J Vestib Res 25(3-4):105-117. doi:10.3233/VES-150553 · PMID 29056234
Bárány Society Committee for Classification of Vestibular Disorders operational diagnostic criteria for BPPV — established and emerging syndromes.

Acknowledgements

Concept, content, and design: Dr Prahlada N.B (Karnataka ENT Hospital and Research Centre (R), Champions Educational and Medical Society (R), and Amogh Foundation, Chitradurga, Karnataka, India).

The HINTS Atlas is part of a series of interactive teaching atlases for vestibular and otology education. The series includes the VEMP Atlas, the SVV Atlas, and the Nystagmus Atlas.

All authors of cited works are credited as the originators of the findings presented in this atlas. Synthesised teaching content is the responsibility of the author; any errors of summary or emphasis are his.

Citing this atlas

If you wish to reference the HINTS Atlas, please use:

Prahlada N.B. HINTS Atlas — an interactive teaching atlas of the Head Impulse, Nystagmus, and Test of Skew exam. Karnataka ENT Hospital and Research Centre, 2026. Available at: hints-atlas [installation URL].