Suspected neurological conditions: recognition and referral

Context

Around 10% of visits to GPs and hospital emergency departments are made by people with symptoms or signs associated with neurological conditions. Many of these people will need referral to a specialist for diagnosis and treatment, but others can have their condition managed in primary care.

Currently there is a lack of support to help non-specialists identify when a referral for specialist investigation of neurological symptoms or signs should be made. This has led to delays in referral for people with treatable or potentially serious neurological conditions, and unnecessary referrals for others. Although many specialist professional and charitable bodies have produced guidance on specific neurological conditions, there is a need for overarching guidance that covers a wide range of neurological symptoms and signs.

This guideline provides recommendations on clinical assessment in non-specialist settings and indications for referral to specialist care (including referral for people with existing neurological conditions). The guideline focuses on the signs and symptoms that are most frequently under- or over-referred, or cause uncertainty among non-specialists. In some recommendations, additional educational information is provided to help guide non-specialists. If a sign or symptom is covered by other NICE guidance, a cross-referral to that guidance is included.

Because of a lack of published evidence in this area, the recommendations are largely based on the guideline committee's knowledge and experience. Some recommendations were also reviewed by external experts. Detailed information on how the recommendations were developed is in the methods section of the full guideline.