Implications
Skew deviation is also part of the ‘HINTS’ protocol first described by
Kattah in 2013;23 this clinical exam is used to
distinguish peripheral vestibular pathologies from more dangerous
strokes in patients with an acute vestibular syndrome. It consists of a
battery of three tests; the Head Impulse Test, the observation of a
Nystagmus and the Test of Skew.23 Since VOG is already
used for head impulse recordings24 and nystagmus
detection in the ED,25 we suggest to measure skew
deviations with the same VOG equipment as well. Such an approach would
not only allow an examiner-independent diagnostic test at the
point-of-care, but it would also provide a quantification and automated
assessment of vertical skew in the future.26