Neurology
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Emergency
If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.
Adult
Stroke/transient ischaemic attack (TIA)
- Patient with acute neurological symptoms of a stroke; multiple/crescendo TIA
- New acute symptoms
Progressive loss of neurological function
- Acute onset severe:
- ataxia
- vertigo
- visual loss
- Acute severe exacerbation of known MS
Seizures/epilepsy
- Status epilepticus/epilepsy with concerning features:
- first seizure
- focal deficit post-ictally
- seizure associated with recent trauma
- persistent severe headache > 1 hour post-ictally
- seizure with fever
Headache/migraine
- Headache with concerning features:
- sudden onset/thunderclap headache
- severe headache with signs of systemic illness (fever, neck stiffness, vomiting, confusion, drowsiness)
- first severe headache age > 50 years
- severe headache associated with recent head trauma
- recent onset headaches in young obese females
- headaches with papilledema
- >50 years with raised CRP/ESR or if giant cell arteritis or vasculitis suspected
Movement disorders
- Ocular
Other referrals to emergency
- Altered level of consciousness
- Bilateral limb weakness with or without bladder and/or bowel dysfunction
- Acute rapidly progressive weakness (Guillain-Barre Syndrome, myelopathy)
- Delirium/sudden onset confusion with or without fever
Paediatric
Seizures/epilepsy
Headaches/migraine
Functional neurological symptoms
- The patient is unable to mobilize safely or has frequent falls/seizure like attacksAddition
Movement disorder
Hypotonic infant
Gait abnormality, isolated motor delay or focal weakness
Stroke
Other neurological conditions
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CPC in scope Not an exhaustive list
Please note this is not an exhaustive list of all conditions for outpatient services and does not exclude consideration for referral unless specifically stipulated in the CPC out of scope section.
- Fetal conditions with neurological risk PAEDIATRIC
- Functional neurological symptoms PAEDIATRIC
- Gait abnormality, isolated motor delay or focal weakness PAEDIATRIC
- Headaches/migraine PAEDIATRIC
- Headaches/migraine ADULT
- Hypotonic infant PAEDIATRIC
- Movement disorders PAEDIATRIC
- Movement disorders including Parkinson’s disease (PD), dystonia and essential tremor ADULT
- Other neurological conditions PAEDIATRIC
- Peripheral neuropathy ADULT
- Progressive loss of neurological function, including multiple sclerosis (MS), motor neurone disease (MND), myasthenia gravis and other neuromuscular disorders ADULT
- Seizures/epilepsy ADULT
- Seizures/epilepsy PAEDIATRIC
- Stroke PAEDIATRIC
- Stroke/transient ischaemic attack (TIA) ADULT
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CPC out of scope
The following are not routinely provided in a public Neurology service.
Adult
- Mild or tension headache
- Untreated headache/migraine
- Dementia without prior assessment by physician or geriatrician
- Syncope (consider cardiology)
- Fibromyalgia/chronic fatigue syndrome
- Lyme disease
- Head injury including concussion (consider neurosurgery)
- See specific Spine CPC
- Chronic unexplained pain/ pain syndrome
- Back and Neck Pain including radicular pain
- Whiplash injuries
Paediatric
Last updated: 13 June 2023