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Afferent pupillary function, confrontation fields and ophthalmoscopic findings were normal.
There was no spontaneous or gaze-evoked nystagmus, including when fixation was removed with Frenzel goggles. The HINTS test is a validated, 3-step series of bedside oculomotor examination maneuvers for the differentation of stroke from acute peripheral vertigo.
Less common causes (that I won't talk about today): perilymph fistula, superior canal dehiscence, autoimmune inner ear disease, otosclerosis, cardiac arrhythmia, and medication side effects.
Video demonstrates head-impulse, nystagmus, test of skew (HINTS) assessment: Head-impulse test in acute vestibular syndrome. Video demonstrates head-impulse, nystagmus, test of skew (HINTS) assessment: Spontaneous nystagmus and gaze testing in acute vestibular syndrome.
Video demonstrates head-impulse, nystagmus, test of skew (HINTS) assessment: Test of skew in acute vestibular syndrome.
Video demonstrates the supine roll (Pagnini-McClure) test to determine the affected side in horizontal canal benign paroxysmal positional vertigo.

This maneuver should evoke paroxysmal positional nystagmus for right-sided benign paroxysmal positional vertigo related to the posterior semicircular canal.
Head impulse tests in unilateral vestibular loss: vestibulo-ocular reflex and catch-saccades.
Spontaneous nystagmus and gaze testing in a patient who presented with acute vestibular syndrome and findings that localize to the right vestibular nerve. The most common form of the disorder affects the posterior semicircular canal and is diagnosed with the Dixa€“Hallpike maneuver. The side that induces the most intense horizontal positional nystagmus is presumed to be the affected side. No nystagmus was provoked by sustained head shaking, hyperventilation or mastoid vibration. On movements to the patient's left side, the eyes stay focused on the target in front of him. A positive Dixa€“Hallpike test is manifested as upbeating torsional nystagmus with a fast component that rotates toward the undermost ear (video).

With head movements to the patient's right side, however, the eyes move off the target (move with the head to the right side), and then he makes a voluntary corrective saccade to bring the eyes back to the target.
The velocity of the nystagmus increases when he looks to the left and decreases when he looks to the right. This nystagmus may be seen with the unaided eye but is often more pronounced if fixation is eliminated with the use of Frenzel lenses or video-oculography goggles. Note that the corrective saccade is more obvious after some of the head-impulse tests than others. This is likely due to variation in the speed of the movement and the patient's ability to predict the movement.
HINTS to Diagnose Stroke in the Acute Vestibular Syndrome: Three-Step Bedside Oculomotor Examination More Sensitive Than Early MRI Diffusion-Weighted Imaging.

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