Neurological: Guidelines for Urgent Referral

• Subacute progressive neurological deficit developing over days to weeks (e.g. weakness, sensory loss, dysphasia, ataxia).

• New onset seizures characterised by one or more of the following:
• Focal seizures
• Prolonged post-ictal focal deficit (longer than one hour)
• Status epilepticus
• Associated inter-ictal focal deficit

• Patients with headache, vomiting and papilloedema.

• Cranial nerve palsy (e.g. diplopia, visual failure including optician defined visual field loss, unilateral sensorineural deafness).

Consider urgent referral for:

• Patients with non-migrainous headaches of recent onset, present for at least one month, when accompanied by features suggestive of raised intra cranial pressure (e.g. woken by headache; vomiting; drowsiness).

NB. This last guideline is intended to provide the primary care physician with the discretion to decline urgent referral if there are other known features (e.g. depression, somatisation disorder) making a diagnosis of brain tumour very unlikely.