Sahu Ankit Kumar, Shrimal Prawal, Ekka Meera, Amrithanand V T, Nayer Jamshed, Aggarwal Praveen
Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India.
J Family Med Prim Care. 2022 Feb;11(2):784-786. doi: 10.4103/jfmpc.jfmpc_1248_21. Epub 2022 Feb 16.
Vertigo is not an uncommon presenting symptom in patients presenting to the emergency department (ED) and primary physician's clinic, and around one-tenth of these patients have a central cause, i.e., posterior circulation stroke. HINTS, the acronym for head impulse (HI) test, nystagmus (N), and test of skew (TS), is a neurological examination utilized for differentiating a peripheral cause of vertigo from a sinister central cause. It is a simple, easy-to-do, inexpensive, and less time-consuming test. Here, we present a 27-year young male case without any known comorbidity or trauma, presented to the ED, with complaints of sudden onset isolated vertigo for 2 hours. HINTS examination pointed towards a central cause (normal head impulse test and direction-changing nystagmus). Other neurological and systemic examinations were normal. Non-contrast computed tomography of the brain was normal. Further, computed tomography angiography of head and neck vessels was performed, showing left vertebral artery dissection (VAD). The patient's neurological status deteriorated in the next 8 hours. The patient underwent decompressive craniotomy and got discharged after two weeks. Early performance of the HINTS examination by the primary care physicians and emergency physicians lead to early diagnosis and treatment of this common cause of posterior circulation stroke in young patients. Essential take-home points are the importance of the HINTS test and not to forget VAD as a cause of isolated vertigo without any neck manipulation or trauma.
眩晕是急诊科（ED）和基层医生诊所患者中并不少见的就诊症状，其中约十分之一的患者病因在中枢，即后循环卒中。HINTS是头部脉冲（HI）试验、眼球震颤（N）和偏斜试验（TS）的首字母缩写，是一种用于区分眩晕外周病因与严重中枢病因的神经学检查。它是一种简单、易于操作、成本低廉且耗时较少的检查。在此，我们报告一例27岁年轻男性病例，无任何已知合并症或外伤史，因突发孤立性眩晕2小时就诊于急诊科。HINTS检查指向中枢病因（头部脉冲试验正常且眼球震颤方向改变）。其他神经学和全身检查均正常。脑部非增强计算机断层扫描正常。此外，对头颈部血管进行了计算机断层扫描血管造影，显示左椎动脉夹层（VAD）。患者在接下来的8小时内神经状态恶化。患者接受了减压开颅手术，并在两周后出院。基层医疗医生和急诊科医生早期进行HINTS检查，有助于对年轻患者后循环卒中这一常见病因进行早期诊断和治疗。重要的要点是HINTS检查的重要性，以及不要忘记VAD可作为无任何颈部操作或外伤情况下孤立性眩晕的病因。
