Headache

Raised ICP, rapid deterioration, rupture into the ventricles; immunocompromise

New seizure in an adult, progressive focal deficit, raised-ICP features → urgent imaging; impending herniation

Reduced consciousness, neurological signs, cardiac ischaemia, pregnancy → consider hyperbaric oxygen

Seizures, reduced GCS, venous haemorrhagic infarction, pregnancy/postpartum

Intestinal perforation/GI bleeding (third week) → surgical emergency

Visual symptoms (amaurosis/visual loss) → ophthalmological emergency; the OTHER eye is at risk → immediate high-dose IV/

BP ≥160/110, severe headache/visual symptoms, epigastric pain, clonus, HELLP, eclamptic seizure → emergency

Papilloedema/retinal haemorrhages with very high BP (≥180/120) = malignant hypertension → same-day assessment for end-or

Progressive visual field loss / worsening papilloedema → sight-threatening, urgent ophthalmology

Severe/complicated falciparum malaria (cerebral, hypoglycaemia, acidosis, AKI, high parasitaemia) → medical EMERGENCY →

Aura + COCP (stroke risk → COCP is UKMEC 4); thunderclap or new focal/systemic features → exclude secondary causes (see

Papilloedema + focal neurology → urgent neuroimaging for a space-occupying lesion/haemorrhage

Hypertensive crisis (can be precipitated by anaesthesia, beta-blockade alone, or contrast) → emergency

Reduced GCS, focal deficit, rebleeding (highest risk first 12h), hydrocephalus, vasospasm (delayed ischaemia)

Stridor/airway compromise, cerebral oedema (severe headache, confusion) → emergency treatment

New pattern, red-flag features (see panel) → exclude secondary causes; medication-overuse if frequent analgesia

Cerebral toxoplasmosis in HIV → urgent treatment; the key differential is primary CNS lymphoma (both ring-enhancing)

Visual field loss (bitemporal hemianopia) / pituitary apoplexy → urgent

Painful red eye + haloes + nausea + fixed mid-dilated pupil = AACG — sight-threatening, refer immediately

Non-blanching rash, septic shock, reduced GCS, focal signs/seizures → do not delay antibiotics; signs of raised ICP

Stroke/TIA from dissection → urgent stroke pathway; thrombolysis decisions need imaging confirmation

Critical neonatal coarctation presenting as collapse when the duct closes → PROSTAGLANDIN to reopen/maintain the duct +

Red-flag features (weight loss, fever, focal neurology, true weakness, abnormal bloods) → investigate for an alternative

Visual field loss from a macroprolactinoma → urgent

Pituitary APOPLEXY (sudden severe headache, visual loss, ophthalmoplegia, hypotension) → emergency (steroids + neurosurg

Deterioration with new consolidation → secondary bacterial pneumonia (esp. Staph. aureus) → antibiotics

Any visual loss/amaurosis with GCA features ≥50 yrs → immediate high-dose steroids + same-day referral, do not wait for

Non-blanching rash, septic shock, reduced GCS, focal signs/seizures, raised-ICP signs → do not delay antibiotics

Any unilateral adult glue ear, a persistent neck node, or cranial nerve palsies → urgent ENT (nasendoscopy + biopsy)

Excessive sleepiness with driving/occupational risk → advise re driving and DVLA notification (group 1: stop until contr