When the presentation is acute and persistent, treat the vertigo syndrome as a localization problem, not just a symptom. HINTS is most useful when the examiner is confident enough to separate peripheral vestibular neuritis from central ischemia.

Vertebral artery dissection can present with isolated vertigo or dizziness; Posterior circulation TIA or stroke can cause vertigo as the only symptom; Vestibular neuritis is a common peripheral cause of acute persistent vertigo; HINTS stands for Head Impulse, Nystagmus, and Test of Skew; Surgical approaches target the posterior semicircular canal in select inner ear disorders