HINTS Exam
Labs
POC glucose
CBC
Chemistry
Coags
Troponin
T&S
ECG
In large ICH or<unk> , may see deep TWI and prolong QT, occ ST changes
Head CT (non-contrast)
In ischemia<unk>  CT has sensitivity 42%, specificity 91%
In acute ICH the sensitivity is 95-100%
The goal of CTH is to identify<unk>  mimics (ICH, mass lesions, etc .)
Also consider:
CTA brain and neck
To check for large vessel occlusion for potential thrombectomy
Determine if there is carotid stenosis that warrants endarterectomy urgently
Pregnancy test
CXR (if infection suspected)
UA (if infection suspected)
Utox (if ingestion suspected)
POC glucose
CBC
Chemistry
Coags
Troponin
T&S
In large ICH or<unk> , may see deep TWI and prolong QT, occ ST changes
In ischemia<unk>  CT has sensitivity 42%, specificity 91%
In acute ICH the sensitivity is 95-100%
The goal of CTH is to identify<unk>  mimics (ICH, mass lesions, etc .)
CTA brain and neck
To check for large vessel occlusion for potential thrombectomy
Determine if there is carotid stenosis that warrants endarterectomy urgently
Pregnancy test
CXR (if infection suspected)
UA (if infection suspected)
Utox (if ingestion suspected)
To check for large vessel occlusion for potential thrombectomy
Determine if there is carotid stenosis that warrants endarterectomy urgently
MRI Brain with DWI, ADC (without contrast) AND
Cervical vascular imaging (ACEP Level B in patients with high short-term risk for<unk> :
MRA brain (without contrast) AND
MRA neck (without contrast)
May instead use Carotid CTA or US (Carotid US slightly less sensitive than MRA) (ACEP Level C)
MRA brain (without contrast) AND
MRA neck (without contrast)
May instead use Carotid CTA or US (Carotid US slightly less sensitive than MRA) (ACEP Level C)
May instead use Carotid CTA or US (Carotid US slightly less sensitive than MRA) (ACEP Level C)
Cerebellar stroke
Vestibular/otologic
Multiple sclerosis
Benign paroxysmal positional vertigo 
Amyotrophic lateral sclerosis
Traumatic 
Acute flaccid myelitis
Infection