Signs of raised intracranial pressure / herniation — worsening headache, vomiting, declining consciousness, unequal pupils, or focal deficit — emergency evaluation/transfer.

Delayed intracranial bleed after a head strike (especially on an anticoagulant) — any new headache, vomiting, confusion, drowsiness, or focal deficit — transfer.

CSF leak — clear fluid from the incision or nose after neurosurgery — urgent neurosurgery notification (route rhinorrhea to Nose/Sinuses).

Surgical-site or deep infection — spreading erythema, purulence, or fever at a craniotomy site — escalate; sepsis → transfer.