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