Stroke Medicine referrals

Contact

Stroke Nurse Practitioner

• 07769 932 342
• 07971 717 588

Stroke Consultant or on-call SpR

Available via calling Switchboard 24 hours a day.

Advice and referral

All contacts and referrals are treated as advice and referral. This is the most efficient way to get the right care, to the right patient, at the right time. It may also mean that investigations are suggested either for primary care or before the first appointment.

Need for admission or urgent treatment in some cases

Unlike many specialties there are several situations where admission is needed rather than advice or a clinic appointment. These include, but are not limited to:

• Persistent neurological symptoms
• Fluctuating symptoms
• Problems swallowing
• Patients on full anticoagulation (warfarin/DOAC)
• Blood pressure >180/100
• Crescendo TIAs
• Possible dissection causing TIA (facial/neck pain with stroke symptoms)

It is vital that all referrals are discussed with the Stroke Nurse Practitioner or the on-call Stroke Consultant before referral, in case immediate admission is needed.

How to make a good Stroke Medicine referral

We require a minimum dataset to allow us to provide effective triage or appropriate advice. On referral, specific advice needs to be followed to ensure the correct management and safety of the patient.

Please fill in the referral form (see 'Downloads' section) and make sure the instructions are followed and relevant information provided:

• Onset date and time of symptoms
• Duration of symptoms (if not resolved then will generally need admission not clinic)
• Clinical examination findings (remembering unilateral symptoms are typical in stroke)
• Relevant past medical history and current medication
• Giving aspirin 300mg immediately and daily until seen (or clopidogrel if allergic)
• ECG to ensure not in atrial fibrillation
• Do not drive until seen
• Call 999 if symptoms recur

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What we deal with in Stroke Medicine

• Suspected transient ischaemic attacks (TIAs)
• TIAs causing unilateral visual loss (must be referred first to Birmingham and Midland Eye Centre (BMEC) which takes precedence
• Acute stroke (anyone with ongoing neurology due to a suspected stroke should be told to attend the Emergency Department rather than being referred)
• Recent stable stroke that has yet to be investigated (from another area in the UK or abroad)
• Advice and guidance about stroke or transient ischaemic events and treatment that has occurred in the past or that we have seen previously

What we do not deal with in Stroke Medicine

Syncope

A single episode of triggered syncope does not need to be referred as long as the patient has a normal ECG. Recurrent syncope needs to be referred to Cardiology for advice on suitable investigation and management.

Vertigo

Patients should be referred to local Ear, Nose and Throat (ENT) services.

Migraine

Migraine patients are generally managed by Neurology if complex.

Amnesia

Transient global amnesia, in the absence of any focal neurology is not a TIA and does not need referral to Stroke Medicine. Advice and guidance can be used to request a scan in primary care. For recurrent episodes, please consider epilepsy and a Neurology referral.

Memory problems

Gradual deterioration should be referred to local memory services. Acute deterioration may need early imaging or admission, but not under Stroke Medicine.

Non-stroke symptoms

Stroke does not generally cause either headache, nor loss of consciousness, or paraesthesia in isolation. Bilateral symptoms are also very unlikely to be stroke related. Please consider an alternative diagnosis and referral route.

Rehabilitation

Patients with ongoing rehabilitation needs, including those arising from previous stroke, may be better managed by the West Midlands Rehabilitation Centre in Selly Oak or by Moseley Hall Hospital.

Incidental imaging findings

Patients without stroke symptoms who have an incidental finding of small vessel disease and white matter changes on brain imaging do not need referral. They should have their vascular risk factors reviewed, especially an ECG and treated from a primary prevention point of view. If there is a significant old stroke event that you wish to discuss, please use advice and guidance.

Referral form

The 'Stroke, TIA and Stroke Medicine Advice and Guidance Referral Form' is available from the 'Downloads' section.

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As stroke and TIA services are considered an emergency service, please be aware that patients will be seen in their local service rather than a choice of hospitals.

Please email the completed form to the relevant address for your local hospital.

Queen Elizabeth Hospital Birmingham

• QEHB.Stroke@uhb.nhs.uk

Good Hope, Heartlands and Solihull hospitals

• HGS.Stroke@uhb.nhs.uk

Patients outside of Birmingham

Patient referrals outside of the local Birmingham area may be forwarded to the following hospitals where relevant:

• Midland Metropolitan University Hospital
• Worcestershire Royal Hospital
• Russells Hall Hospital