Create flow diagram for vertigo as per nice cks guidelines

Flow Diagram for Management of Vertigo in Primary Care (NICE CKS)

• Step 1: Initial Assessment
  Assess symptoms, medical history, and clinical findings in adults (≥18 years) presenting with vertigo ¹.
• Step 2: Identify Red Flags for Central Causes
  Check for hyperacute onset (max intensity in minutes), neurological signs (new headache, gait disturbance, truncal ataxia, vertical or torsional nystagmus), acute unilateral deafness, or new headache ¹.
• Step 3: Urgent Referral or Admission
  If any red flags present, refer immediately for specialist assessment or admit to hospital to exclude brainstem stroke or other central causes ¹,³.
• Step 4: Consider Peripheral Vertigo Causes
  If peripheral vertigo suspected (e.g., benign paroxysmal positional vertigo, Meniere's disease, vestibular neuronitis), manage accordingly or refer to balance specialist if diagnosis unclear ¹,².
• Step 5: Symptomatic Treatment
  Offer short-term symptomatic drug treatment (up to 1 week) with prochlorperazine, cinnarizine, cyclizine, or promethazine teoclate for nausea, vomiting, and vertigo ¹. Avoid benzodiazepines due to lack of evidence and dependence risk ¹.
• Step 6: Severe Symptoms
  If severe nausea/vomiting prevents oral intake or drug treatment, consider hospital admission or urgent referral ¹.
• Step 7: Specialist Referral for Undetermined Cause
  If vertigo cause remains unclear after assessment, refer to an ear, nose, and throat specialist, audiovestibular physician, neurologist, or geriatrician with balance expertise, urgency based on clinical judgement ¹.
• Step 8: Vestibular Rehabilitation
  For vestibular neuronitis or unilateral vestibular hypofunction, consider vestibular rehabilitation to improve symptoms and function ².
• Step 9: Monitor and Seek Specialist Advice if Symptoms Deteriorate
  If symptoms worsen or new neurological signs develop, seek specialist advice promptly ¹.