skip to main content

HINTS – Peripheral — SCE Neurology MCQ

Instant feedback + full explanation. One question, done properly.

HardCerebrovascular DiseaseHINTS – PeripheralSCE Neurology

A 64-year-old has continuous vertigo, spontaneous nystagmus, nausea and severe gait unsteadiness for 8 hours. A junior doctor with no formal HINTS training records “peripheral HINTS”; non-contrast CT is normal. There is no clear benign positional or postural explanation. What is the safest next step?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Refer immediately through the acute stroke pathway for expert assessment

HINTS can be useful in an acute vestibular syndrome only when performed and interpreted by a clinician trained and experienced in its use. Because the recorded result came from an untrained examiner, it cannot exclude posterior-circulation stroke; a normal early non-contrast CT is also insufficient. NICE advises immediate stroke-pathway referral when acute vestibular syndrome is not explained by benign paroxysmal positional vertigo or postural hypotension and a trained HINTS examiner is unavailable. Vestibular suppressants or delayed imaging must not postpone that assessment.

Reference: NICE NG127, suspected neurological conditions: https://www.nice.org.uk/guidance/ng127/chapter/Recommendations-for-adults-aged-over-16