HINTS Exam to rule out Central cause of Vertigo
The HINTS exam (Head-Impulse, Nystagmus, Test of Skew) is reported to be more sensitive for diagnosing stroke than early MRI diffusion-weighted imaging for patients with vertigo symptoms.  Unfortunately this is also one of the most complex and misunderstood physical exam tests.  The HINTS exam should not be interpreted in the setting of a patient without acute vestibular syndrome.  Abnormal findings for a patient without vestibular syndrome are reassuring as they suggest a peripheral cause of vertigo.  A reassuring HINTS exam should have unidirectional nystagmus, no vertical skew, and an abnormal head impulse test.  You can use these these video clips to teach learners the subtleties of the HINTS exam at the bedside. Special thanks to Dr. Dr. Peter Johns @PeterJohns84 for wonderful video clips.

peripheral central headimpulse nystagmus skew