Advice and Guidance - Neurovascular/Stroke

Overview

The Neurovascular advice and guidance service is not for patients with acute symptoms. Please see appropriate referral routes below:

• Acute Stroke - For any patient with ongoing stroke symptoms, however mild, please follow the guidance on the Stroke page.
• TIA  - patients with fully resolved symptoms please continue to refer to TIA clinic immediately after their consultation following the guidance on the TIA page.

If you are uncertain which pathway to follow please call the IUC Weekday Professional Line or for urgent advice direct from the stroke team please see NBT Stroke team contact details below.

Neurovascular Advice and guidance

A Neurovascular/Stroke Advice & Guidance Service is available via eRS to all BNSSG practices, as well as to Senior Stroke Specialists working in community stroke services.

Advice and guidance requests will be checked daily (Monday to Friday) and the Stroke Team will endeavour to reply to requests for advice within 24 hours or the next working day at the latest.

Typical areas which this service covers are:

• Secondary prevention following stroke or TIA
• Management of complications or persistent symptoms after stroke or venous sinus thrombosis
• Questions about need for screening for intracerebral aneurysms
• Advice regarding vascular findings on cerebral imaging such as small vessel disease, asymptomatic infarcts, intracranial or extracranial vessel stenosis or dissection, cavernomas or features suggestive of cerebral amyloid angiopathy.

• However:
  • Symptomatic or Incidental arteriovenous malformations (AVMs) or intracerebral aneurysms should be referred to the neurovascular surgery team / MDT

To enable the consultants to give the best advice possible, please consider the following points:

• Give a clear concise history, examination findings and clinical question - avoid cutting and pasting long lists of consultation notes that are not relevant to the problem in hand.
• Include relevant results, investigations and recent correspondence if appropriate but avoid multiple attachments that can take time to download and make the triage process more cumbersome.
• Avoid requests for complex patients known to an individual consultant as they are unlikely to be the consultant giving the advice and may not have easy access to details of previous contacts with the patient. In these cases consider writing or emailing the relevant secretary directly.
• Include patient contact details including up to date telephone number. Also include contact details for the referrer including a direct contact or mobile telephone number if possible.

 Exclusions

• Not for acute TIA / Stroke referrals - see above.
• Not for routine Neurovascular clinic referrals - refer via neurovascular eRS
• Not for General Neurology and Emergency HOT Clinic queries - please see the Neurology Advice & Guidance and HOT Clinic page 
• Not for neurovascular surgery referrals - please see Neurosurgery page.

UHBW Stroke Advice & Guidance

There is no stroke service at UHBW.

All requests for stroke advice and guidance should now be submitted to NBT from the whole of BNSSG.

NBT Neurovascular/Stroke Advice & Guidance

Urgent (same day) advice

If you would like urgent A&G directly from the stroke team please call

• Stroke A&G phone on 0117 414 5619 (8am-4pm Mon-Fri)
• or Stroke SpR (Bleep 1490 via Southmead switchboard) at all other times. 

Non-Urgent advice

For non-urgent Stroke/Neurovascular Neurology Advice & Guidance please use eRS. Requests will be responded to within 24h or the next working day at the latest. 

Please see the NBT – Neurovascular Neurology A&G Guidance document for further guidance on how to submit a request through e-Referral.

Please process through e-Referral bypassing the Referral Service. Advice requests should ideally be typed into the free text window of the advice request body on e-RS rather than attaching a separate letter or Word document.  If you attach a Clinical Information Summary, please ensure it is named this, so that clinicians at secondary care can opt to look at it if they wish to turn the request into a referral.

• Neurovascular/Stroke Advice and Guidance - Southmead - RVJ

Priority - Routine 
Specialty - Neurology
Clinic - Stroke (Not TIA)

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.