Is That a Balance Problem or a Stroke? — Here’s How to Tell

by Neil Bauman, Ph.D.

If all of a sudden you feel dizzy and your balance is off, has something just happened to the balance parts of your inner ears, or have you just had an ischemic stroke in your brain? Your doctor needs to determine what has happened right away.

Up to now, doctors typically ordered MRIs to look for a blood clot in your brain which would indicate a stroke. Unfortunately MRIs are both expensive and do not always find tiny blood clots, especially at the outset.

Now researchers at Johns Hopkins and the University of Illinois have discovered a fast, accurate, low-tech way to determine which is which. Your doctor can tell in under a minute whether you’ve just had a stroke or not. Here’s how he can do it.

Your doctor gives you a three-part eye test called H.I.N.T.S. (In case you’re interested, H. I. stands for “head impulse”, N.T. for “nystagmus test” and S. for “skew”.)

First, is the Head Impulse Test. Here your doctor rotates your head while you keep your eyes focused on his nose. If you have had a stroke you cannot do this. However, if you have an inner ear balance problem, you can keep focused on his nose.

Second, is the Nystagmus Test. You follow your doctor’s finger as he moves it. If you have a balance problem, your eyes will jerk in only one direction. However, if you have had a stroke, your eyes will most likely jerk in both directions.

Third, is the Skew Test. Here your doctor looks at your eyes to see if one eye appears higher than the other. If one eye is higher than the other, you have had a stroke. If they are the same level, then it could be inner ear balance problems.

According to David E. Newman-Toker, MD, PhD, assistant professor of neurology at Johns Hopkins University School of Medicine and coauthor of this study. “These three eye tests tell, with 96% certainty, whether or not the patient has had a stroke.”

According to Bottom Line’s Daily Health News, December 14, 2009, “Dr. Newman-Toker advises seeking attention for any dizziness that comes on unexpectedly and has no obvious explanation, particularly if it lasts more than a few seconds. In situations where you still feel dizzy when you arrive at the ER, request the eye tests, he says, but be aware that not every doctor has the training and experience to perform them.”