If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.
Non-acute skull fracture/ non- acute traumatic brain injury
- Acute trauma
- Change in conscious level or deteriorating neurological functions
- Head trauma with seizures
Brain tumours (intracerebral, meningioma, skull base, pituitary)
- Symptoms of signs of raised intracranial pressure
- Severe and increasing headache
- Deteriorating neurological function
- Seizures
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
Spine
- Actual or threatened cauda equina syndrome
- bilateral nerve pain (leg pain below knees)
- unexplained or unexpected loss of bladder or bowel function
- perineal anaesthesia
- progressive weakness
- Spinal tumour with significant pain and/or neurological deficit
- Clinical signs spinal nerve root compression or spinal cord compression with rapidly progressive neurological signs/symptoms
- Spinal trauma with significant pain and/or neurological deficit
- Spinal fractures demonstrated on imaging
- Clinical suspicion of spinal infections
- High risk of irreversible deficit if not assessed urgently
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 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
