Figure. Head impulse test. A: The right ear has intact peripheral vestibular function. When the head is turned to the right, the vestibulo-ocular reflex moves the eyes to maintain visual fixation. B: The right ear now has impaired vestibular function. When the head is turned to the right, the eyes move with it, breaking visual fixation, and a refixation saccade is seen as the eyes dart back to the examiner’s face. This indicates a peripheral vestibular disorder on the right side. Reprinted from The Lancet Neurology, Vol. 7, Edlow JA, Newman-Toker DE, and Savitz SI, Diagnosis and initial management of cerebellar infarction”, Page No. 959, Copyright 2008, with permission from Elsevier. [West J Emerg Med. 2009;10(4):273-277.]

共分为三个步骤：

1. 嘱患者头部放松，注视你的鼻子，轻柔左右晃动患者转向一边，然后突然加速转回正中位，头部脉冲阳性则表现为头转回后可见补偿性扫视，如补偿性扫视出现较晚，则考虑中枢性病灶

2. 观察患者有无眼球震颤

3. 倾斜试验

由于急性前庭综合征（AVS）以持续性眩晕为特征，可能由良性内耳疾病或卒中引起，对于临床医师来说，常常与后循环脑梗死难以鉴别。前面也提到了头脉冲试验-眼球震颤-倾斜试验是一项床边评估，但在发病24小时内诊断脑梗死非常有用，甚至比头颅MRI更为敏感。本研究作者团队旨在探讨一线临床医生对于使用HINTS诊断AVS的观点。

Figure 1. (A) Training types that respondents have used for learning and performing HINTS assessment, and types of formal training that respondents requested. (B) The perceived confidence of performing HINTS (n=42). Note that no respondent was ‘very confident’, with the majority rating themselves as being ‘not or slightly confident’. (C) The likelihood to request further investigation even if no central pathology was suspected when using HINTS (n=42). Most participants were somewhat or very likely to request a scan or second opinion. HINTS, head Impulse-nystagmus-test of skew.

来源：SVN俱乐部

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