What are the appropriate referral criteria for a patient with paralysis suspected to be due to a neurological condition?

Refer adults presenting with paralysis suspected to be caused by a neurological condition according to the following criteria:

• Sudden-onset limb or facial weakness: Refer urgently for assessment as this may indicate stroke or transient ischaemic attack, following local stroke pathways and NICE stroke guidelines.
• Rapidly progressive symmetrical limb weakness (within 4 weeks): Refer immediately for neurological assessment including bulbar and respiratory function evaluation.
• Rapidly progressive weakness of a single limb or hemiparesis (within hours to days): Refer urgently using a suspected cancer pathway referral for neuroimaging and further investigation.
• Slowly progressive limb or neck weakness (weeks to months): Refer for neuromuscular disorder assessment, urgently if swallowing impairment is present, and immediately if breathlessness at rest or when lying flat occurs.
• Severe low back pain with new bladder, bowel, sexual dysfunction, or perineal numbness: Refer immediately for assessment of possible cauda equina syndrome.

These referral criteria ensure timely specialist neurological assessment to diagnose and manage potentially serious neurological causes of paralysis.

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