Proposed as method of distinguishing peripheral cause from cerebellar/brain stem CVA in the Emergency Department population. 
Only to be used in patients with persistent dizziness, not those with resolved symptoms.
HINTS exam should only be used in patient with acute persistent<unk> , nystagmus, and a normal neurological exam.
Test of vestibulo-ocular reflex function
When the head is turned towards the normal side, the vestibular ocular reflex remains intact and eyes continue to fixate on the visual target
When the head is turned towards the affected side, the vestibular ocular reflex fails and the eyes make a corrective saccade to re-fixate on the visual target 
Normally, a functional vestibular system will identify any movement of the head position and rapidly correct eye movement accordingly so that the center of the vision remains on a target.
This reflex fails in peripheral causes of<unk>  affecting the vestibulocochlear nerve
It is reassuring if the reflex is abnormal (due to dysfunction of the peripheral nerve)
This reflex fails in peripheral causes of<unk>  affecting the vestibulocochlear nerve
No nystagmus (normal) or only horizontal unilateral nystagmus is reassuring
Any other type of nystagmus is abnormal, including bidirectional nystagmus
Skew deviation is a fairly specific predictor of brainstem involvement in patients with acute vestibular syndrome. The presence of skew may help identify stroke when a positive head impulse test falsely suggests a peripheral lesion.
Skew is also known vertical dysconjugate gaze and is a sign of a central lesion
A positive HINTS exam: 100% sensitive and 96% specific for the presence of a central lesion.
The HINTS exam was more sensitive than general neurological signs: 100% versus 51%.
The sensitivity of early MRI with DWI for lateral medullary or pontine stroke was lower than that of the HINTS examination (72% versus 100%, P=0.004) with comparable specificity (100% versus 96%, P=1.0).
If any of the above 3 tests are consistent with CVA obtain full work-up (including MRI)
Vertigo
Vestibular/otologic
Tinnitus
Benign paroxysmal positional vertigo 
Sympathetic ophthalmia
Traumatic 
Herpes zoster ophthalmicus
Infection