Review of 18 years' experience of a diagnostic geriatric neurology referral service

From 1971 to 1989, 1446 cases were referred from Glasgow and the West of Scotland to the University Department of Geriatric Medicine for neurological diagnosis. In that time, the number increased from one per week to more than two per week, and the proportion from outside Glasgow from 2% to 24%. Eighty-seven per cent had CT scans and 8% electrophysiological studies. One third of patients stayed three days or less, and one third over a week. Cerebrovascular disease was diagnosed in 637 cases (44%), subdural haematoma or hygroma in 59 (4%), and intracranial tumour in 228 (16%), of which 26 (11%) were benign. In 104 cases (7%) no definite diagnosis was made. Management was changed in 402 of the 1446 cases (28%). In the 635 (44%) in whom a referring diagnosis was documented, this was not confirmed in 63%; diagnosis and/or management was changed in 80%. The proportions of referring diagnoses of subdural haematoma and intracranial tumour that were confirmed rose with time. The value of the service lay in the speed and ease of access to it, and the opportunities for teaching and learning it provided. The problems it posed were those of the transfer of ill patients, the distances sometimes necessary, and the need for high standards of communication.