Use of the Head Impulse, Nystagmus, Test of Skew ('HINTS') assessment to aid differential diagnosis in acute vestibular syndrome in the hyperacute stroke setting.

Background: Differential diagnosis of acute vertigo syndrome is challenging given the similarities between clinical presentations of posterior circulation stroke and peripheral vestibular dysfunction. The Head Impulse, Nystagmus, Test of Skew ('HINTS') assessment is a clinical bedside test used to aid diagnosis.

Methods: Comprehensive training on use of the Head Impulse, Nystagmus, Test of Skew assessment was provided to one stroke consultant, and the effectiveness of the test in that setting was assessed.

Severe hypomagnesaemia due to lansoprazole.

A 71-year-old woman, who had been taking lansoprazole for 18 months for dyspepsia, presented with vomiting, thought to be due to gallstones, and was found to have severe hypomagnesaemia. She was treated with intravenous and then oral magnesium, and discharged, but was soon readmitted with symptoms due to hypomagnesaemia, and again treated with magnesium supplementation. No other recognised cause for hypomagnesaemia was found.