This guideline covers the initial assessment of symptoms and signs that might indicate a neurological condition. It helps non-specialist healthcare professionals to identify people who should be offered referral for specialist investigation.

In July 2019, following user feedback we changed the timing of referral from urgent to immediate for adults with sudden-onset speech or language disturbance and children under 4 years with a change in head circumference and signs or symptoms of raised intracranial pressure.


This guideline includes recommendations for:

Who is it for?

  • Non-specialist healthcare professionals in primary and secondary care
  • Healthcare professionals in neurology departments
  • People with suspected neurological conditions, their families and carers

Is this guideline up to date?

We checked this guideline in September 2021. We will cross-refer between this guideline and our guideline on recognition and referral of suspected cancer to clarify when referrals for children with an absent red reflex, with or without a new-onset squint, should be immediate or urgent. We will explain that immediate referral for loss of red reflex with a new-onset squint is recommended because this may indicate potential neurological conditions in addition to retinoblastoma.

Guideline development process

How we develop NICE guidelines

Your responsibility

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian. 

All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.

Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

  • National Institute for Health and Care Excellence (NICE)