Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 7 Sept 2026Clinical review pending
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Acute vestibular syndrome may be stroke
Continuous new vertigo with vomiting and gait disturbance can reflect posterior circulation ischaemia despite an apparently isolated balance complaint.
Action: Activate the emergency stroke pathway for focal signs or central HINTS findings, and for unexplained acute vestibular syndrome when an appropriately trained HINTS examiner is unavailable.
Synopsis
Use the timing of dizziness, eye movements, hearing and neurological examination to choose the correct bedside assessment and recognise posterior circulation stroke.
Establish whether symptoms are continuous, spontaneously episodic or triggered brief attacks.
Head movement worsens many vestibular disorders; worsening alone does not diagnose BPPV.
Use HINTS only in the appropriate ongoing acute vestibular syndrome and with trained expertise.
Key red flags
New diplopia, dysarthria, limb incoordination, severe truncal instability or unilateral deafness accompanying acute vertigo requires immediate assessment for a central or vascular cause.
Investigation priorities
01
Immediate observations and targeted neurological assessmentFirst step
Identify physiological instability and neurological features that change urgency.
Management branches
EmergencyPossible posterior circulation event
New continuous vertigo accompanies central signs or remains diagnostically unsafe.
Record onset, activate the stroke pathway and arrange emergency transfer; do not wait for routine outpatient ENT review.
Provide monitored supportive care, assess hydration and swallowing safety, and communicate any anticoagulant use or recent neck trauma.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 7 Sept 2026; clinical approval remains outstanding.