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Peripheral vertigo versus central vertigo. Application of the HINTS protocol

A. Batuecas-Caletrío, R. Yáñez-González, C. Sánchez-Blanco, E. González-Sánchez, J. Benito, J.C. Gómez, S. Santa Cruz-Ruiz [REV NEUROL 2014;59:349-353] PMID: 25297477 DOI: https://doi.org/10.33588/rn.5908.2014137

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Volumen 59 | Number 08 | Nº of views of the article 28.869 | Nº of PDF downloads 3.366 | Article publication date 16/10/2014

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ABSTRACT

INTRODUCTION One of the most important dilemmas concerning vertigo in emergency departments is its differential diagnosis. There are highly sensitive warning signs in the examination that can put us on the path towards finding ourselves before a case of central vertigo.

AIM To determine how effective the application of the HINTS protocol is in the diagnosis of cerebrovascular accidents that mimics peripheral vertigo.

PATIENTS AND METHODS We conducted a descriptive observation-based study on patients admitted to hospital with a diagnosis of acute vestibular syndrome in the emergency department. All the patients were monitored on a day-to-day basis until their symptoms improved, with information about nystagmus, the oculocephalic manoeuvre and the skew test. The results from the magnetic resonance imaging study were compared with the alteration of any of those three signs during the time the patient was hospitalised.

RESULTS Altogether 91 patients were examined, with a mean age of 55.8 years. A cerebrovascular accident was observed in eight cases. Of these (mean age: 71 years), in seven of them there were alterations in some of the HINTS signs, and in one case the study was normal (sensitivity: 0.88; specificity: 0.96). All of them had some vascular risk factor.

CONCLUSIONS Faced with a patient who visits the emergency department with an acute vestibular syndrome, a suitably directed examination is essential to be able to establish the differential diagnosis between peripheral and central pathology, since some cerebrovascular accidents can present with the appearance of acute vertigo. Applying a protocol like HINTS makes it possible to suspect the central pathology with a high degree of sensitivity and specificity. KeywordsBrainstem Cerebellum Dizziness Imbalance Vertigo Vestibular neuritis CategoriesMareos, vértigos y acufenos

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Original

Peripheral vertigo versus central vertigo. Application of the HINTS protocol