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.
Adult
- Collapse/altered level of consciousness/new neurological deficit
- Suspected subarachnoid haemorrhage or other intracranial haemorrhage
- Headache with Red flags:
- 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
Spine, Neck, Back Pain
NB: contact the Orthopaedic Registrar on 3810 1111. For Neurosurgery and Spine conditions please call the Neurology or Spinal Registrar at The Princess Alexandra Hospital on 3176 2111
- High risk of irreversible deficit if not assessed urgently
- Spinal infections
- Significant spinal nerve root compression or spinal cord compression with progressive neurological signs/symptoms e.g.
- Spinal cord compression with severe or rapidly progressing neurological deficit
- Cauda equina syndrome
- Bilateral nerve pain (leg pain below knees)
- Bladder / bowel dysfunction
- Perineal anaesthesia
- Progressive weakness
- Bone infection
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