Neuro testings for IM providers

[Redpancreas]

Two questions here.

1.) For hospitalists when rounding on patients or called for a rapid response of altered mental status (assuming patient follows commands), what is your go-to neuro exam to rule out a focal deficit? I've carried the stroke pager independently as an intern and am aware of the NIH-SS, stat-CT non con, etc. but you can't NIHSS every single patient. One solution to that is selectively use NIHSS, but was wondering if anyone has had any insight into what manuevers are most sensitive? Or do you just go for the NIHSS everytime you're looking for a focal deficit?

2.) For clinic physicians, say a patient comes in with vertigo/visual sx. and you want to rule out a posterior circulation stroke because while it sounds like vertigo, it might be something else. I have heard of the so-called HINTS test during grand rounds where the sensitivity/specificity was comparable to an MRI. Have any of you ever caught a posterior circulation stroke with it and is this HINTS test something you do in clinical practice?

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[DrMetal]

Two questions here.

1.) For hospitalists when rounding on patients or called for a rapid response of altered mental status (assuming patient follows commands), what is your go-to neuro exam to rule out a focal deficit?

Non con head CT, then an MRI.

Stop effing around, none of those scorings tests nor the neuro exam (I don't care how good you are at it, not even neurologists trust their own exams) are reliable . . . and they're certainly not defensible in court if you miss an intracranial process.
NO ONE WILL DEFEND YOU! Get the head imaging.

 

[Redpancreas]

Non con head CT, then an MRI.

Stop effing around, none of those scorings tests nor the neuro exam (I don't care how good you are at it, not even neurologists trust their own exams) are reliable . . . and they're certainly not defensible in court if you miss an intracranial process.
NO ONE WILL DEFEND YOU! Get the head imaging.

Thanks as always @DrMetal