Direct to an emergency department for:
- Transient ischaemic attack(s) in last 48 hours
- Multiple or recurrent transient ischaemic attack episodes in the last seven days
- Amaurosis fugax in last 48 hours
- Persistent neurological deficit.
Immediately contact the neurology registrar to arrange an urgent neurology assessment for:
- Transient ischaemic attack(s) that has occurred more than 48 hours ago and within the last two weeks.
Criteria for referral to public hospital specialist clinic services
- Internal carotid stenosis (> 50%) on imaging with symptoms (excluding dizziness alone), more than two weeks after onset of symptoms
- Asymptomatic internal carotid stenosis > 70% on imaging
- An old stroke identified on imaging that has not been previously addressed.
Information to be included in the referral
Information that must be provided
- Timing and severity of symptoms
- Neuroimaging results
- Vascular imaging results
- Current and complete medication history (including non-prescription medicines, herbs and supplements).
Provide if available
- Full blood examination
- Liver function tests
- Fasting blood glucose level
- Fasting lipid profile
- Any echocardiogram or Holter monitor results
- International normalised ration (INR) > 1.5 in patients taking an anticoagulant medicine.
- If symptoms are thought to be linked to probable or confirmed SARS CoV-2 (COVID-19) infection or Long COVID.
The Summary and referral information lists the information that should be included in a referral request.
Where appropriate and available the referral may be directed to an alternative specialist clinic or service.
Referral to a public hospital is not appropriate for
- An old stroke identified on imaging that has been previously addressed
- Age appropriate, asymptomatic deep white matter disease or T2-hyperintense lesions
- Chronic vascular risk factors without an acute transient ischaemic attack or stroke
- Primary prevention of vascular risk.