Neurosurgery

Non-acute skull fracture/ non- acute traumatic brain injury

• Acute trauma
• Change in consciousness level or deteriorating neurological functions i.e. :   increasing headache or local pain at site of trauma, development of nausea, vomiting and or decrease in conscious level, seizure, development of focal neurological signs
• Head trauma with seizures

Brain tumours (intracerebral, meningioma, skull base, pituitary)

• Symptoms or signs of raised intracranial pressure
• Severe and increasing headache
• Deteriorating neurological function i.e. increasing headache and/or nausea vomiting, decrease in conscious level, seizure, development of focal neurological signs
• Seizures
• Suspected glucocorticoid deficiency

Neurovascular disorders (aneurysm, AVMs, other)

• Symptoms of signs of raised intracranial pressure
• Severe and increasing headache
• Deteriorating neurological function
• Seizures
• Clinical suspicion or subarachnoid haemorrhage or intracerebral haemorrhage

Hydrocephalus and VP shunt

• Symptoms of signs of raised intracranial pressure
• Increasing severity of headache
• Deteriorating neurological function
• Seizures
• Swelling pain or redness along shunt tract
• Abdominal pain or swelling
• Clinical suspicion of shunt infection

Trigeminal neuralgia and other cranial nerve abnormalities

• Severe intractable pain preventing adequate fluid intake

Back and/or Neck Pain

• Cauda equina syndrome
• High energy spinal trauma
• Suspected epidural abscess or discitis

Request for advice / eConsult

• Where diagnosis of the following Minimum referral consult conditions is equivocal, eConsult is available to provide timely advice in regard to diagnosis, investigations, or management OR 
• May be provided on receipt of a referral if eConsult is deemed to better meet the needs of the patient.

Peripheral nerve compression including carpal tunnel syndrome, ulnar nerve entrapment neuropathy, common peroneal and lateral cutaneous nerve of thigh compression syndromes

• Acute development of peripheral nerve compression symptoms following trauma

Other Neurosurgical Conditions

• Symptoms of signs of raised intracranial pressure
• Severe and increasing headache
• Deteriorating neurological function
• Seizures

Other referrals to emergency not covered within conditions:

Adult

• Collapse/altered level of consciousness/new neurological deficit
• Suspected subarachnoid haemorrhage or other intracranial haemorrhage
• 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 over 50 years
  • severe headache associated with recent head trauma
• Symptomatic benign or malignant space-occupying lesion
• Suspected or proven blocked or infected VP shunt
• Acute hydrocephalus
• Head injuries/trauma including extensive scalp laceration or suspected traumatic brain injury
• Trigeminal neuralgia – severe uncontrollable pain

Paediatric

• Benign or malignant space occupying lesion associated with midline shift, hydrocephalus, neurological or endocrine deficit
• Acute hydrocephalus
• Suspected or proven blocked or infected VP shunt
• Vascular disorders – suspected subarachnoid haemorrhage or other intracranial haemorrhage e.g. Thunderclap headache, collapse/altered level of consciousness, headache with vomiting, new neurological deficit
• Cranial trauma – extradural, subdural haematoma, large cerebral contusion, concussion injuries, diffuse axonal injury, skull fractures, CSF fistula/leakage spinal trauma or other spinal conditions with severe or rapidly progressive deficit e.g. Loss of sensation, muscular weakness or cauda equina syndrome
• Generalised seizures, prolonged focal seizures and persistent neurological deficits