Refer immediately adults with sudden-onset dizziness and a focal neurological deficit such as vertical or rotatory nystagmus, new-onset unsteadiness or new-onset deafness, to exclude posterior circulation stroke, in line with the NICE guideline on stroke and transient ischaemic attack in over 16s NICE NG127.
Refer immediately adults with sudden-onset acute vestibular syndrome in whom benign paroxysmal positional vertigo or postural hypotension do not account for the presentation, if a healthcare professional with training and experience in the use of the HINTS test is not available NICE NG127.
Refer adults with sudden-onset acute vestibular syndrome who have indications of stroke on the HINTS test (such as a normal head impulse test, direction-changing nystagmus or skew deviation) for neuroimaging NICE NG127.
Refer adults with recurrent fixed-pattern dizziness associated with alteration of consciousness for epilepsy assessment NICE NG127.
Refer children with new-onset blackouts (transient loss of consciousness) accompanied by seizure markers for neurological assessment NICE NG127.
Refer urgently children with blackouts under 12 years for paediatric assessment NICE NG127.
Refer children with mid-activity vacant spells or behavioural outbursts associated with altered consciousness or amnesia for assessment NICE NG127.