ABSTRACT NUMBER: ESOC2026A1756 A DECADE OF DIZZINESS REFERRALS TO A SPECIALIST TIA SERVICE: A HIGH-RISK CEREBROVASCULAR PRESENTATION

Abstract Background and aims Dizziness is common, accounting for 3–5% of Emergency Department attendances. Despite this, dizziness is often considered a low-risk presentation for cerebrovascular disease, with reported stroke rates in ED cohorts <5%. This study aimed to quantify burden of dizziness presentations to a large tertiary TIA clinic and determine the proportion subsequently diagnosed with stroke/ TIA. Methods We prospectively collected a database of consecutive referrals to a central London TIA service from June 2015 to November 2025. Referral reasons were categorised into common symptom clusters of potential neurological aetiology. “Dizziness” was used here to encompass vestibular symptoms as informed by Bárány Society classification: dizziness, vertigo, unsteadiness, giddiness, and imbalance. Using R software, we calculated the proportions of patients presenting with dizziness and those then diagnosed with confirmed or probable stroke/TIA. Logistic regression was used to compare diagnostic outcomes between symptom groups. Results Of 12760 new referrals identified, “dizziness” was a reason for 14% of referrals (n=1,783). Of these, 31% (n=547) were diagnosed with confirmed or probable stroke/TIA. Among patients referred for isolated “dizziness”, 24% (n=241/994) received a stroke/TIA diagnosis. The presence of additional neurological symptoms significantly increased diagnostic likelihood to 39% (n=306/789; OR = 1.98 [95% CI 1.62 – 2.43], p < 0.001). Conclusions In a specialist TIA clinic population, patients referred with isolated vestibular symptoms had a stroke/ TIA diagnosis rate over four-fold higher than estimates from ED-based cohorts. These findings challenge the perception of dizziness as a low-risk cerebrovascular presentation and support lower referral thresholds for patients with vestibular symptoms. Conflict of interest Sashini Mariathasan: nothing to disclose; Rashad Alijam: nothing to disclose; Clara Tierney: nothing to disclose; Teona Serafimova: nothing to disclose; Arvind Chandratheva: nothing to disclose; Diego Kaski: nothing to disclose; Mohammad Mahmud: nothing to disclose