July 2019: We changed the timing of referral from urgent to immediate for adults with sudden-onset speech or language disturbance and for children under 4 years with a change in head circumference and signs or symptoms of raised intracranial pressure (see recommendations 1.13.1 and 1.22.3).
Minor changes since publication
October 2021: In recommendation 1.30.1, we added a cross-reference to NICE's guideline on suspected cancer. We also updated the rationale for this recommendation to clarify that new-onset squint with loss of red reflex may indicate a neurological condition associated with raised intracranial pressure or a brain tumour. See the surveillance report for more information.
In recommendation 1.16.1, we added a link to NICE's guideline on shared decision making.