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Peripheral vertigo versus central vertigo. Application of the HINTS protocol<br />
Introduction. One of the most important dilemmas concerning vertigo in emergency departments is its differential diagnosis.<br />
There are highly sensitive warning signs in the examination that can put us on the path towards finding ourselves before<br />
a case of central vertigo.<br />
Aim. To determine how effective the application of the HINTS protocol is in the diagnosis of cerebrovascular accidents that<br />
mimics peripheral vertigo.<br />
Patients and methods. We conducted a descriptive observation-based study on patients admitted to hospital with a<br />
diagnosis of acute vestibular syndrome in the emergency department. All the patients were monitored on a day-to-day<br />
basis until their symptoms improved, with information about nystagmus, the oculocephalic manoeuvre and the skew test.<br />
The results from the magnetic resonance imaging study were compared with the alteration of any of those three signs<br />
during the time the patient was hospitalised.<br />
Results. Altogether 91 patients were examined, with a mean age of 55.8 years. A cerebrovascular accident was observed<br />
in eight cases. Of these (mean age: 71 years), in seven of them there were alterations in some of the HINTS signs, and in<br />
one case the study was normal (sensitivity: 0.88; specificity: 0.96). All of them had some vascular risk factor.<br />
Conclusions. Faced with a patient who visits the emergency department with an acute vestibular syndrome, a suitably<br />
directed examination is essential to be able to establish the differential diagnosis between peripheral and central pathology,<br />
since some cerebrovascular accidents can present with the appearance of acute vertigo. Applying a protocol like HINTS<br />
makes it possible to suspect the central pathology with a high degree of sensitivity and specificity.<br />
Key words. Brainstem. Cerebellum. Dizziness. Imbalance. Vertigo. Vestibular neuritis.<br />
www.neurologia.com Rev Neurol 2014; 59 (8): 349-353<br />
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