Acute Neurology Rapid Access Clinics (HOT Clinics)

The Neurology Rapid Access Clinic (or ‘HOT’ clinics) is a consultant-led clinic which provides rapid access to neurology assessment for adults with either acute or sub-acute neurological symptoms. However, the clinic will not routinely review patients with suspected TIA, who should be referred to the TIA service, or seizures, who should be referred to the ‘first fit’ clinic. The clinic welcomes referrals for patients with either new-onset or recent-onset symptoms (within the last month). Patients with episodic symptoms that are in decline may also be referred to our service.

One of the overarching goals of this clinic is to provide quality, timely assessments of suitable patients, including urgent neuroimaging and neurophysiological assessments should these be needed. We anticipate that this will avoid referrals to acute medicine driven by the need for timely neurological assessment alone. This clinic does not replace the TIA pathway or the hyperacute stroke pathway; all patients with suspected hyperacute stroke must be referred to the on-call stroke service for an emergency assessment of their symptoms.

Inclusion Criteria

There are no other defined inclusion criteria but suitable referral examples include:

1. Acute/subacute change in gait or hand function
2. Acute/subacute cerebellar syndrome
3. Acute/subacute ascending sensori-motor symptoms WITHOUT back pain and/or shortness of breath
4. Mononeuropathy impacting on activities of daily living
5. New, or recent-onset, ophthalmoplegia
6. Suspected idiopathic intracranial hypertension

Exclusion Criteria

1. ANY neurosurgical emergency (e.g., cauda equina, suspected SAH)
2. New-onset and rapidly evolving quadriparesis (e.g., GBS, myasthenia gravis)
3. Rapid cognitive decline/encephalitis/incident psychosis
4. Suspected neurological cancer/tumour (refer via two-week rule)
5. Previously diagnosed chronic neurological disorder (e.g., Parkinson’s disease, multiple sclerosis) with a probable medical decompensation (e.g., intercurrent infection)
6. Suspected TIA (refer via TIA pathway)
7. Chronic headache (i.e., headaches for > 3 months) unless otherwise recommended within the  SWL headache pathway
8. Known MS with suspected MS relapse (refer to local MS relapse clinic)
9. Known Functional Neurological Disorder with deterioration in pre-existing neurological symptoms