What criteria should I use to decide when to refer a patient with dizziness for specialist assessment?

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 ¹.

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 ¹.

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 ¹.

Refer adults with recurrent fixed-pattern dizziness associated with alteration of consciousness for epilepsy assessment ¹.

Refer children with new-onset blackouts (transient loss of consciousness) accompanied by seizure markers for neurological assessment ¹.

Refer urgently children with blackouts under 12 years for paediatric assessment ¹.

Refer children with mid-activity vacant spells or behavioural outbursts associated with altered consciousness or amnesia for assessment ¹.