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Neurology referral criteria – Adult

Neurology referral criteria – Adult

Emergency neurology referrals

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergency medical advice if in a remote region.

  • >50 years with raised CRP/ESR with suspected temporal arteritis
  • Acute neurological symptoms of a stroke; multiple/crescendo TIA
  • Acute onset or rapid progression (over hours or days) motor impairment with functional loss
  • Acute onset severe progressive ataxia, vertigo and/or visual loss
  • Acute rapidly progressive weakness (Guillain-Barre Syndrome, myasthenia gravis, myelopathy)
  • Acute severe exacerbation of known MS
  • Bilateral leg weakness with or without bladder and/or bowel dysfunction
  • Ear conditions with associated neurological signs i.e. facial palsy
  • First severe headache age >50 years
  • Headaches with papilledema or focal neurological signs
  • New acute stroke/TIA patients
  • Patients with acute neurological symptoms of a stroke within the past 7 days
  • Prolonged post-ictal period
  • Seizure without known history of seizure disorder
  • Seizures due to substance withdrawal
  • Severe headache associated with recent (1-2 days) head trauma or if on anticoagulants
  • Severe headache with signs of systemic illness (fever, neck stiffness, vomiting, confusion, drowsiness)
  • Status epilepticus/epilepsy with concerning features:
    • Focal deficit post-ictally
    • Seizure associated with recent trauma
    • Persistent severe headache > 1 hour post-ically
    • Seizure with fever
  • Sudden onset delirium or confusion with or without fever
  • Sudden onset/thunderclap headache
  • Sudden movement disorder involving ocular movement
Immediate neurology referrals

Immediate referrals (seen within 7 days) are not handled by the Central Referral Service (CRS).

Do not send immediate referrals via CRS – send referrals for patients requiring immediate review (within the next 7 days) directly to the relevant hospital.

Immediately contact the on-call registrar or service to arrange an immediate neurology assessment for:

  • Abnormal neurological exam with concerning features, including malignancy or neuroimaging (new onset headache)
  • Idiopathic intracranial hypertension 
  • Rapidly progressing cognitive changes (over weeks)
  • Severe/acute trigeminal neuralgia with inability to eat
  • Severe symptoms or abrupt onset/deterioration of movement disorder

To contact the relevant service, please see HealthPathways: Acute Neurology Assessment

Adult neurology conditions with Referral Access Criteria
Please note this is not an exhaustive list of all conditions for public adult neurology outpatient services and does not exclude consideration for referral unless specifically stipulated in the RAC excluded section
Excluded neurology services

Out of scope/excluded procedures

Botulinum therapy for chronic migraine – please refer to the Headaches in Adults – Community HealthPathways Western Australia (external site) HealthPathway

Excluded procedures will not be performed unless under exceptional circumstances and where a clear clinical need has been identified. For all excluded procedure referrals, state clearly in the referral that request is for an excluded procedure and include the clinical exception reason as to why it should be considered.

The WA Elective Surgery Access and Waiting List Management Policy may be accessed via the WA health Policy Frameworks page.

Referral to public neurology outpatient services is not routinely accepted for the following conditions

Condition Details (where applicable)
Acquired brain injury Specific exclusions:
  • Chronic sequelae of acquired brain injury, except for epilepsy.
  • Post-concussion syndrome or rehabilitation of acquired brain injury (consider referral to Rehabilitation Medicine / Community Rehabilitation / Day Therapy / State Head Injury Unit as appropriate).

Please refer to the following HealthPathways:
Certification of a patient’s ability to drive, for private standards, in the presence of a neurological condition Unless specified as a requirement by the Department of Transport (see Austroads Guidelines (external site) for assessing the fitness to drive).

Please refer to the following HealthPathways:
Chronic headache where standard treatment has not been tried

Consider trialling conservative/standard treatment.

Please refer to the following HealthPathway:
Chronic low back pain, neck pain or radicular pain; chronic pain or non-specific pain syndromes

Consider referral to pain services and/or allied health as appropriate.

Please refer to the following HealthPathway:
Chronic neurological conditions that are well controlled and do not require additional intervention For example: chronic epileptic patient on stable drug therapy and no seizures for 10 years, do not need to be referred for ‘routine’ review.
Cognitive impairment > 65-year-old

Consider referral to geriatric medicine and aged care services as appropriate. Patients whose primary and major diagnosis/symptomatology are alcohol, drug or psychiatry related (consider referral to drug and alcohol service or mental health service as first line).

Please refer to the following HealthPathway:
Lyme disease or Lyme-like illness

Please refer to:
Fibromyalgia/Chronic Fatigue Syndrome

Consider referral to rheumatology/pain services/general medicine, as appropriate.

Please refer to the following HealthPathways:
Neurological symptoms due to treatment non-adherence
  • e.g. seizures
Parkinson’s disease > 65 years old unless referred by specialist

Consider referral to geriatric medicine/community rehabilitation/day therapy Unit as appropriate.

Please refer to the following HealthPathways:
Distal symmetrical painful sensory neuropathy associated with diabetes or alcoholism

Patients with long history of distal symmetrical painful sensory neuropathy associated with diabetes or alcoholism referred for pain management (consider referral to Chronic Pain service).

Please refer to the following HealthPathway:
Restless leg syndrome Please refer patients to Sleep Medicine
Small‑fibre neuropathy previously diagnosed by a neurologist

If referred for symptom management, consider referral to Pain service.

Please refer to the following HealthPathway:
Seizures known to relate to drug/alcohol use

Consider referral to drug and alcohol services as appropriate.

Please refer to the following HealthPathway:
Sleep disorders

Consider referral to sleep medicine as appropriate.

Please refer to the following HealthPathway:
Syncope

Consider medical or cardiology referral as appropriate.

Please refer to the following HealthPathways:
Tremor of long duration or milder severity Please refer to the following HealthPathway:
Uncomplicated Bell’s palsy

Routine follow-up

Please refer to the following HealthPathway:
Vertigo with hearing loss

Consider ENT referral as appropriate.

Please refer to the following HealthPathway:
Workers compensation and medico-legal cases

Please refer to:
Last reviewed: 30-05-2023

More information

Email: DOHSpecialistRAC@health.wa.gov.au

wa.gov.au