Progressive loss of neurological function

Emergency and immediate referrals

Referral to Emergency Department

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:

Acute onset severe progressive ataxia, vertigo and/or visual loss
Acute severe exacerbation of known MS
Acute rapidly progressive weakness (Guillain-Barre Syndrome, myasthenia gravis, myelopathy)
Bilateral leg weakness with or without bladder and/or bowel dysfunction

Immediately contact on-call registrar or service to arrange an immediate neurology assessment (seen within 7 days) for:

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

Presenting symptoms
Progressive loss of neurological function

Mandatory referral information (referral will be returned if this information is not included)
History Relevant history, onset and duration of symptoms including Evolution of symptoms - progressive, stable or improving State which neurological symptom/dysfunction is progressing e.g. weakness, ataxia, diplopia, oropharyngeal dysphagia, visual field, cognition State onset, speed of progression and what function(s) is affected Degree of functional impairment (e.g. impact on mobility/falls/employment/ADLs/weight loss/carer information) Relevant past medical history Examination Physical examination including: Visual fields Full neurological examination If unable to attach reports, please include relevant information/findings in the body of the referral Referrer to state reason if not able to include mandatory information in referral (e.g. patient unable to access test due to geographical location or financial cost)

Mandatory referral information (referral will be returned if this information is not included)

History

Relevant history, onset and duration of symptoms including
- Evolution of symptoms - progressive, stable or improving
- State which neurological symptom/dysfunction is progressing e.g. weakness, ataxia, diplopia, oropharyngeal dysphagia, visual field, cognition
  - State onset, speed of progression and what function(s) is affected
Degree of functional impairment (e.g. impact on mobility/falls/employment/ADLs/weight loss/carer information)
Relevant past medical history

Examination

Physical examination including:
- Visual fields
- Full neurological examination

If unable to attach reports, please include relevant information/findings in the body of the referral

Referrer to state reason if not able to include mandatory information in referral (e.g. patient unable to access test due to geographical location or financial cost)

Highly desirable referral information
CK TFTs Vitamin B12 Acetylcholine Receptor Antibodies EMG/NCS MRI neuraxis (brain/spinal cord) Cognitive scores Indicate whether the patient has previously attended a neurology clinic or seen a neurologist, or any other specialist doctor e.g. urologist If so please attach contact details, dates and any other information and correspondence relating to these visits.

Indicative triage category

Indicative triage category
Category 1 Appointment within 30 days	Rapidly progressive neurological or visual field deficit including weakness, ataxia or cranial nerve deficits (e.g. MS, MND, myositis)
Category 2 Appointment within 90 days	Progressive neurological or visual field deficit including weakness, ataxia or cranial nerve deficits (e.g. MS, MND, myasthenia gravis, myositis)
Category 3 Appointment within 365 days	Chronic or slowly deteriorating neurodegenerative illness

Last reviewed: 29-06-2023

Progressive loss of neurological function

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