NICE Publishes Quality Standards for the Management of Suspected Neurological Conditions

Priscilla Lynch 

January 12, 2021

The quality statements are as follows:

Statement 1: Children under 12 years with headache and 'red flag' symptoms are referred immediately for neurological assessment.

Any one of the following is considered a red flag symptom in children <12 years:

  • headache that wakes them at night;

  • headache that is present on awakening in the morning;

  • headache that progressively worsens;

  • headache triggered or aggravated by coughing, sneezing or bending down;

  • headache with fever and features of meningism;

  • headache associated with vomiting;

  • headache associated with ataxia (disorders that affect co-ordination, balance and speech);

  • headache associated with change in conscious level or pervasive lethargy;

  • headache occurring within five days of a head injury; and

  • headache associated with squint or failure of upward gaze ('sunsetting').

Statement 2: Children under four years with suspected abnormal head size or shape have their head circumference assessed using a standardised growth chart.

Statement 3: Adults with suspected dystonia are referred for neurological assessment.

Statement 4: Adults with transient rotational vertigo on head movement are assessed using the Hallpike manoeuvre to check for benign paroxysmal positional vertigo (BPPV) in adults with vertigo on head movement.

If BPPV is confirmed, treatment to relieve it using a canalith repositioning manoeuvre can be given.

Statement 5: Adults diagnosed with a functional neurological disorder are supported to manage symptoms that are a part of the disorder in non-specialist care.

Symptoms such as dizziness, recurrent limb or facial weakness, memory problems and numbness and tingling can be managed outside of specialist services, with referral for neurological assessment if new signs or symptoms are present.

Statement 6: Adults with suspected neurological conditions using NHS services experience care and treatment that is tailored to their needs and preferences.

This quality standard is expected to contribute to improvements in time to diagnosis, unnecessary attendance at emergency departments, health-related quality of life for people with existing neurological conditions and patient experience of adult NHS services.

This article originally appeared on Univadis, part of the Medscape Professional Network.

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