From the Guidelines
The HINTS assessment is a useful tool to screen for stroke in patients presenting with acute vertigo, and it is recommended to be used by experienced examiners, such as neurologists, to accurately differentiate strokes from mimics. The HINTS assessment is particularly useful in evaluating patients with abnormal neurologic examination or suspected central vertigo, as it has been found to be better than the ABCD2 score in some studies 1. However, it is essential to note that the accuracy of HINTS may be dependent on the examiner's experience, and a meta-analysis suggests that if HINTS is used in isolation by emergency physicians, it is not adequately sensitive to exclude a stroke in patients presenting with acute vertigo 1.
Key Components of HINTS Assessment
- Evaluation of neurologic signs, including headache, weakness, and speech difficulties
- Assessment of vestibular function, including nystagmus and balance
- Examination of cerebellar function, including coordination and gait
- Evaluation of other clinical features, such as duration and severity of symptoms
Implementation of HINTS Assessment
To implement the HINTS assessment, a trained healthcare professional, preferably a neurologist, should conduct the evaluation in a quiet environment where the patient can perform various physical tasks. The assessment should include a thorough evaluation of the patient's neurologic signs, vestibular function, cerebellar function, and other clinical features. After completing the assessment, the results should be used to determine the likelihood of stroke and guide further management, including imaging studies and treatment plans. Regular reassessment may be necessary to monitor improvement and adjust treatment plans accordingly, as recommended by recent clinical guidelines 1.
From the Research
Definition and Assessment of Neuropathic Pain
- Neuropathic pain is defined as pain arising as a direct consequence of a lesion or disease affecting the somatosensory system either at peripheral or central level 2
- Clinical examination, including accurate sensory examination, is the basis of neuropathic pain diagnosis 2
- Screening questionnaires are suitable for identifying potential patients with neuropathic pain, but further validation of them is needed for epidemiological purposes 2
Tools and Methods for Assessment
- Quantitative sensory testing is recommended for selected cases in clinic, including the diagnosis of small fiber neuropathies and for research purposes 2
- Measurement of trigeminal reflexes mediated by A-beta fibers can be used to differentiate symptomatic trigeminal neuralgia from classical trigeminal neuralgia 2
- Measurement of laser-evoked potentials is useful for assessing function of the A-delta fiber pathways in patients with neuropathic pain 2
- Skin biopsy to measure the intraepidermal nerve fiber density should be performed in patients with clinical signs of small fiber dysfunction 2
Pain Assessment and Mechanisms
- Thorough pain assessment must address multiple domains of pain, including the sensory and affective qualities of pain, temporal dimensions of pain, and the location and bodily distribution of pain 3
- Pain assessment should also incorporate methods to identify pathophysiological mechanisms underlying the pain 3
- The intensity of pain and treatment effect (both in clinic and trials) should be assessed with numerical rating scale or visual analog scale 2