At SAVES, one of the most common questions we hear is: “When is the right time to refer a neurologic case?”

The short answer? Earlier than you think!

Neurologic disease is uniquely time-sensitive. While some cases declare themselves clearly, many begin subtly, and an early referral can improve both diagnostic efficiency and long-term outcomes. Below are practical referral guidelines we hope are helpful in day-to-day practice.

1. The Non-Ambulatory Patient

Any patient that is non-ambulatory due to suspected neurologic disease warrants urgent referral. In conditions such as acute intervertebral disc extrusion, surgical timing can significantly influence recovery potential. If you think the patient needs to be seen urgently, please give us a call!

2. Progressive Neurologic Deficits

Progression over hours to days (or even weeks) suggests active disease. Worsening paresis, loss of postural reactions, or advancing cranial nerve deficits should prompt referral, even if pain is controlled.

3. Recurrent or Uncontrolled Seizures

A single, well-recovered seizure in a classic idiopathic epilepsy patient may not require immediate referral. However, cluster seizures, status epilepticus, atypical signalment, abnormal interictal exam findings, or poor medication response are strong indications for advanced workup.

4. Multifocal or Brain Localization

Mentation changes, cranial nerve deficits, vestibular signs with ipsilateral postural deficits, or suspected forebrain disease often benefit from advanced imaging and CSF analysis. These cases can be difficult to localize fully without MRI.

5. Pain Without Orthopedic

Explanation Spinal hyperesthesia without radiographic explanation, especially in small-breed dogs or chondrodystrophic patients, should raise suspicion for compressive or inflammatory spinal cord disease.

6. When You’re Uncertain

Perhaps the most important indication: when the neuro exam doesn’t “add up.” Neurolocalization challenges, mixed signals, or a case that simply feels atypical are all appropriate reasons to reach out.

Our goal is always collaborative care. We are happy to co-manage stable epilepsy patients, provide diagnostic clarification, or take over acute surgical cases; whatever best supports you and your client.

If you ever want to discuss a case before referring, please don’t hesitate to call SAVES at 828-210-8285. We deeply value the partnership we share with you and your team.