Referral to emergency

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.

  • collapse/seizures/vomiting/altered level of consciousness/new neurological deficit
  • abdominal pain or swelling in a shunted patient
  • acute hydrocephalus
  • clinical suspicion of shunt infection
  • suspected or proven blocked ventriculoperitoneal (VP) shunt
  • swelling pain or redness along shunt tract
  • abdominal pain or swelling in a shunted patient
  • in the case of suspected raised intracranial pressure without any of the above features – see clinical management advice

Please contact the on-call registrar to discuss your concerns prior to referral.

For clinical advice, please telephone the relevant metropolitan Local Health Network switchboard and ask to speak to the relevant specialty service.

Women's and Children's Health Network

Category 1 (appointment clinically indicated within 30 days)

  • headaches with papilloedema
  • increasing head circumference in infants < 2 years old crossing centile lines
  • asymptomatic incidental finding of ventriculomegaly in children < 2 years old

Category 2 (appointment clinically indicated within 90 days)

  • asymptomatic incidental finding of ventriculomegaly in children > 2 years old

Category 3 (appointment clinically indicated within 365 days)

  • previously diagnosed and treated hydrocephalus for routine review
  • asymptomatic previously treated patient with hydrocephalus has moved from interstate for routine review

For information on referral forms and how to import them, please view general referral information.

Essential referral information

Completion required before first appointment to ensure patients are ready for care. Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

  • identifies as Aboriginal and/or Torres Strait Islander  
  • identify within your referral if you feel your patient is from a vulnerable population, under guardianship/out-of-home care arrangements and/or requires a third party to receive correspondence on their behalf
  • interpreter required
  • child/parents demographic information including best contact details
  • relevant past medical/surgical history
  • current medications, allergies
  • history of presenting complaint including:
    • onset
    • duration
    • concerning features
    • type/make of shunt - if possible, check previous records, or patient may have implant card)
    • past surgical procedures and year/s completed
    • additional treatments and management including frequency and outcomes
    • previous treating neurosurgeon including location and reason not returning for ongoing care
    • relevant reports or discharge summaries
  • neurological examination findings
  • computed tomography (CT) or medical resonance imaging (MRI) brain
  • confirmation of diagnosis on imaging and associated reports including location, company, and accession number

Clinical management advice

Features of raised intracranial pressure may include:

  • severe and increasing headaches
  • headaches worse in the morning
  • headache exacerbated by coughing, sneezing, straining or bending forwards
  • papilloedema
  • pulsatile tinnitus
  • visual symptoms – including transient reduction in vision with straining

In the case of suspected raised intracranial pressure but without any criteria for referral to emergency:

  • arrange urgent eye examination by an ophthalmologist/optometrist
  • arrange urgent cerebral imaging to exclude space occupying lesion or cerebral venous sinus thrombosis.

If features of raised intracranial pressure with normal cerebral imaging and normal neurological examination, consider idiopathic intracranial hypertension and refer urgently to neurology for consideration of investigation and management

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