Midlands Neurology

Current pathway

Current guidelines and pathways were established by the Pan-Birmingham Cancer network and can be found here.

 

There does seem to be a fair amount of confusion over the process, so in brief:

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• If the patient has overt signs of raised ICP - papilloedema and the like send them to their local emergency department. 

• If the patient has active cancer or HIV and a new headache, seizures, acute or sub-acute cognitive impairment or focal neurological deficit they should be discussed urgently with their oncology or GUM clinician.

• If the patient has had a brain scan which shows a primary brain tumour or metastases they should be discussed with the on-call neurosurgical SpR who will advise and arrange referral to the neuro-oncology MDT.

• If the patient has had a brain scan that shows an incidental finding such as an enlarged pituitary gland or small meningioma then they should be referred to the relevant specialist - endocrinologist for pituitary; neurosurgeon for meningiomas etc.

• If the patient has new headache, seizures, acute or sub-acute cognitive impairment or focal neurological deficit  and has not had any imaging they should be referred for urgent neurological assessment using the '2WW form'.

 

If as a GP you are not sure what to do, please don't just fill in the 2WW form and wait for UHB to sort it out. This  often results in an unnecessary appointment which is a poor use of resources and is not in the patient's best interests. This is particularly true where you or one of your colleagues has arranged the scan and you have a report that you don't understand. That should be discussed with the radiologist who wrote the report.