What are the appropriate referral criteria for a patient with paralysi

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

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.

References:

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