Videooculography "HINTS" in Acute Vestibular Syndrome: A Prospective Study.

Korda, Athanasia; Wimmer, Wilhelm; Zamaro, Ewa; Wagner, Franca; Sauter, Thomas C; Caversaccio, Marco D; Mantokoudis, Georgios (2022). Videooculography "HINTS" in Acute Vestibular Syndrome: A Prospective Study. Frontiers in neurology, 13, p. 920357. Frontiers Media S.A. 10.3389/fneur.2022.920357

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A three-step bedside test ("HINTS": Head Impulse-Nystagmus-Test of Skew), is a well-established way to differentiate peripheral from central causes in patients with acute vestibular syndrome (AVS). Nowadays, the use of videooculography gives physicians the possibility to quantify all eye movements. The goal of this study is to compare the accuracy of VOG "HINTS" (vHINTS) to an expert evaluation.


We performed a prospective study from July 2015 to April 2020 on all patients presenting at the emergency department with signs of AVS. All the patients underwent clinical HINTS (cHINTS) and vHINTS followed by delayed MRI, which served as a gold standard for stroke confirmation.


We assessed 46 patients with AVS, 35 patients with acute unilateral vestibulopathy, and 11 patients with stroke. The overall accuracy of vHINTS in detecting a central pathology was 94.2% with 100% sensitivity and 88.9% specificity. Experts, however, assessed cHINTS with a lower accuracy of 88.3%, 90.9% sensitivity, and 85.7% specificity. The agreement between clinical and video head impulse tests was good, whereas for nystagmus direction was fair.


vHINTS proved to be very accurate in detecting strokes in patients AVS, with 9% points better sensitivity than the expert. The evaluation of nystagmus direction was the most difficult part of HINTS.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Ear, Nose and Throat Disorders (ENT)
04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > University Emergency Center
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology
10 Strategic Research Centers > ARTORG Center for Biomedical Engineering Research > ARTORG Center - Hearing Research Laboratory

UniBE Contributor:

Korda, Athanasia; Wimmer, Wilhelm; Zamaro, Ewa; Wagner, Franca; Sauter, Thomas Christian; Caversaccio, Marco and Mantokoudis, Georgios


600 Technology > 610 Medicine & health




Frontiers Media S.A.




Pubmed Import

Date Deposited:

02 Aug 2022 07:49

Last Modified:

07 Aug 2022 02:08

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Uncontrolled Keywords:

HINTS acute unilateral vestibulopathy stroke vertigo videooculography




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