Terms used in this guideline

Refer immediately

To be seen by the specialist service within a few hours, or even more quickly if necessary.

Refer urgently

To be seen by the specialist service within 2 weeks.


A routine referral.

Consider referring

Consider a routine referral.


A subjective sensation of spinning (vertigo) or a more vague sensation of unsteadiness, and sometimes a feeling of light-headedness or pre-syncope.

Functional neurological disorder

A condition in which people experience neurological symptoms in the absence of any identifiable causative physical or structural abnormality.


Irritation or damage to a nerve root as it exits the spinal canal. It is most commonly caused by mechanical compression from a prolapsed intervertebral disc or degenerative arthritis of the spine. Less frequently, an infection such as herpes zoster or Lyme disease is the cause. Symptoms include neck or low back pain radiating into a limb, tingling (paraesthesia), reduced or absent deep tendon reflex(es) and weakness in the distribution of the nerve root.

Suspected cancer pathway referral

Person to receive a diagnosis or ruling out of cancer within 28 days of being referred urgently by their GP for suspected cancer. For further details, see NHS England's webpage on faster diagnosis of cancer.