Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
Common management strategies for patients with cranial nerve disorders in primary care include:
- Recognition and referral: Promptly identify symptoms such as unilateral facial pain triggered by touching the face (suggestive of trigeminal neuralgia) and refer adults refractory to treatment for specialist assessment following neuropathic pain guidelines NICE NG127.
- Referral for neuroimaging: Refer adults with facial pain associated with persistent facial numbness or abnormal neurological signs urgently using a suspected cancer pathway referral NICE NG127.
- Blood tests and local pathway follow-up: For symptoms suggestive of temporal arteritis (e.g., scalp tenderness, jaw claudication), consider blood tests and follow local pathways for suspected giant cell arteritis, noting that a normal ESR does not exclude the diagnosis NICE NG127.
- Assessment of sudden-onset symptoms: Refer immediately adults with sudden-onset speech or language disturbance for vascular event assessment per stroke pathways NICE NG127.
- Management of vestibular symptoms: For adults with transient rotational vertigo, offer the Hallpike manoeuvre and canalith repositioning manoeuvre if trained personnel are available; otherwise, refer according to local pathways NICE NG127.
- Consideration of functional neurological disorders: Recognize that some cranial nerve symptoms (e.g., dizziness, word-finding difficulties) may be part of functional neurological or anxiety disorders and may not require referral if no new neurological signs are present NICE NG127.
- Referral for suspected dystonia: Refer adults with suspected cervical dystonia or other dystonias for specialist assessment and possible botulinum toxin treatment NICE NG127.
- Monitoring and supportive care: For loss of smell or taste lasting more than 3 months without other neurological signs, consider neuroimaging; routine referral is not required if imaging is normal NICE NG127.