Neurology - School of Medicine Dundee

Part of the School of Dundee and NHS Tayside

Before Making a Referral

This section of the website is for GPs, hospital doctors and other heath care professionals.

Members of the public worried they have a medical problem should discuss their concerns with their GP in the first instance.

 

Many referrals may be better managed in other hospital specialties or in General Practice.

To avoid any delays in onward referrals and expedite treatment, we have prepared specialist pathways and guidance on common referrals:

 

 

 Back pain without neurological signs

We do not routinely see patients with back pain. Please refer to MSK guidelines for further management advice here.

 

 Back pain with neurological signs

We do not routinely see patients with back pain. Please refer to the MSK guidelines for further management advice here.

 

Dementia/memory impairment

Please exclude anxiety or depression before referring to clinic. This could be checked with a Hospital Anxiety and Depression Scale (HADS) and mini-mental state examination (MMSE).

A pathway has been developed for the investigation and referral of dementia in Primary care, and is available on the NHS intranet here.

 

 Suspected First Seizure

We have developed a pathway to assist in referral. It is available on the NHS intranet here.

Otherwise, our referral criteria aresummarised here

 

 Transient loss of consciousness/Syncope

We do not investigate loss of consciousness in neurology, unless it is suspected seizure. Guidance on the investigation and management of non-seizure loss of consciousness can be found on the first seizure pathway here or this more detailed document.

 

 Headache

Headache is a ubiquitous condition.The basis of diagnosis is a good history and examination of the patient.

Most headaches are mild and transient and spontaneously resolve. Where headaches persist or are severe, look for red flag symptoms and signs. Guidance on this can be found here

If red flag symptoms and signs are absent, consider the wide range of primary headaches. Our headache pathway can be found here

Many patients who attend clinic have medication overuse, which is easily treated in General Practice.

Patients are often referred with frequent migraine have been referred without trying at least 3 preventative medications for appropriate periods. Guidance on medication prophylaxis is available from the SIGN guidelines website here.

Pathways for the management of tension type headache can be found here.

Information leaflets to help with management of headache in General Practice are available here.

 

Motor neurone disease

http://neurology.dundee.ac.uk/motor-neurone-disease

 

 Multiple Sclerosis relapses

Guidance on MS management can be found here.

Guidance on the management of MS relapse can be found here.

 

 Neck pain

Neck pain is a common condition. Please see MSK guidance for management of neck pain here.

Guidance from NHS Evidence on its initial management can be found here.

 

 Parkinson's Disease and tremor

Please refer patients over 65 to the Department of Medicine for the Elderly.

Guidance on the acute management of Parkinson's Disease can be found here

Guidance on the management and referral of Parkinson's Disease and tremor can be found here.

 

  Sensory Loss

The following "red flags" would warrant discussion with the oncall neurology registrar, and potentially urgent review:

  • Lhermitte's phenomenon
  • Sensory level
  • Neck pain
  • Rapid progression

 

Carpal and ulnar tunnel syndromes

We don't routinely see patients with carpal or ulnar tunnel syndrome. Advice on their management can be found on MSK guidelines here.

 

Distal sensory loss

Distal sensory loss is a common referral to the service. It would be helpful if common causes for sensory loss could be addressed first in General Practice. These include excess alcohol, B12 and folate deficiency, and diabetes.

If no cause is found and if the symptoms are progressive, referral could be undertaken.

 

Loss of sensation on lateral aspect of thigh (meralgia paresthetica)

Meralgia paresthetica is a common, usually self limiting, benign condition. Advice on its management can be found here.

 

 Sleep clinic

The sleep clinic sees patients with behavioural sleep problems. Unfortunately, we are unable to offer treatment for insomnia at the moment.

A separate respiratory sleep service exists for patients with sleep disordered breathing.

We do not see patients:

  • Who are not "sleepy tired"
  • Who have chronic fatigue

 

Before attending clinic, it would be helpful if patients referred to sleep clinic could complete a:

Sleep diary

Patient questionnaire

Bed partner questionnaire