Referral to emergency
If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.
- collapse/seizures/vomiting/altered level of consciousness/new neurological deficit
- abdominal pain or swelling in a shunted patient
- acute hydrocephalus
- clinical suspicion of shunt infection
- suspected or proven blocked ventriculoperitoneal (VP) shunt
- swelling pain or redness along shunt tract
- in the case of suspected raised intracranial pressure without any of the above features – see clinical management advice
Please contact the on-call registrar to discuss your concerns prior to referral.
For clinical advice, please telephone the relevant metropolitan Local Health Network switchboard and ask to speak to the relevant specialty service.
Central Adelaide Local Health Network
- Royal Adelaide Hospital (08) 7074 0000
Southern Adelaide Local Health Network
- Flinders Medical Centre (08) 8204 5511
Exclusions
- asymptomatic, treated hydrocephalus patients without one of the following:
- clinical deterioration/new symptoms
- transfer of care (interstate/international)
- transition of care from paediatric service
Triage categories
Category 1 (appointment clinically indicated within 30 days)
- headaches with papilloedema and / or visual field defects or optimal coherence tomography (OCT) abnormalities identified by an optometrist/ophthalmologist
- suspected complications of an in-situ ventriculoperitoneal (VP) / lumboperitoneal (LP) shunt
Category 2 (appointment clinically indicated within 90 days)
- history of treated hydrocephalus with headaches but without other symptoms of raised intracranial pressure
- hydrocephalus with suspected normal pressure
- incidental hydrocephalus confirmed with imaging
Category 3 (appointment clinically indicated within 365 days)
- asymptomatic, shunted patients with one of the following:
- transfer of care (interstate/international)
- transition of care from paediatric service
For more on outpatient referrals, see the general referral information page.
Essential referral information
Completion required before first appointment to ensure patients are ready for care. Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.
- identifies as Aboriginal and/or Torres Strait Islander
- relevant social history, including identifying if you feel your patient is from a vulnerable population and/or requires a third party to receive correspondence on their behalf
- interpreter required
- relevant past medical/surgical history
- current medications, allergies
- history of presenting complaint including:
- onset
- duration
- concerning features
- type/make of shunt - if possible, check previous records, or patient may have implant card
- past surgical procedures and year/s completed
- additional treatments and management including frequency and outcomes
- previous treating neurosurgeon including location and reason not returning for ongoing care
- relevant reports or discharge summaries
- neurological examination findings
- computed tomography (CT) or medical resonance imaging (MRI) brain
- confirmation of diagnosis on imaging and associated reports including location, company, and accession number
Additional information to assist triage categorisation
- eye examination - ophthalmologist/optometrist report
Clinical management advice
Features of raised intracranial pressure may include:
- severe and increasing headaches
- headaches worse in the morning
- headache exacerbated by coughing, sneezing, straining or bending forwards
- papilloedema
- pulsatile tinnitus
- visual symptoms – including transient reduction in vision with straining
In the case of suspected raised intracranial pressure but without any criteria for referral to emergency:
- arrange urgent eye examination to an ophthalmologist/optometrist
- arrange urgent cerebral imaging to exclude space occupying lesion or cerebral venous sinus thrombosis.
If features of raised intracranial pressure with normal cerebral imaging and normal neurological examination, consider idiopathic intracranial hypertension and refer urgently to neurology for consideration of investigation and management. See Headache - Neurology CPC.
It is crucial to transfer the care of individuals who have previously been diagnosed and treated for hydrocephalus, especially those who have recently relocated from interstate, or are transitioning from paediatric services. This transfer ensures that relevant medical history and previous imaging scans are accessible in the event of an emergency presentation. Interpretation of imaging for patients with hydrocephalus can be challenging when considered in isolation. Assessing the person in advance helps clinicians to understand their shunt system during acute presentations.Once a baseline has been established, routine reviews are unnecessary, unless there is a decline in clinical condition or a specialist's assessment is clinically required.
