Refer urgently patients with:

• symptoms related to the CNS in whom a brain tumour is suspected, including:
  • progressive neurological deficit
  • new-onset seizures
  • headaches
  • mental changes
  • cranial nerve palsy
  • unilateral sensorineural deafness
• headaches of recent onset accompanied by features suggestive of raised intracranial pressure, for example:
  • vomiting
  • drowsiness
  • posture-related headache
  • pulse-synchronous tinnitus
  • or by other focal or non-focal neurological symptoms, for example blackout, change in personality or memory
• a new, qualitatively different, unexplained headache that becomes progressively severe
• suspected recent-onset seizures (refer to neurologist)

Refer urgently patients previously diagnosed with any cancer who develop any of the following symptoms:

• recent-onset seizure
• progressive neurological deficit
• persistent headaches
• new mental or cognitive changes
• new neurological signs.

Consider urgent referral (to an appropriate specialist) in patients with rapid progression of:

• subacute focal neurological deficit
• unexplained cognitive impairment, behavioural disturbance or slowness, or a combination of these
• personality changes confirmed by a witness and for which there is no reasonable explanation even in the absence of the other symptoms and signs of a brain tumour

Consider non-urgent referral or discussion with specialist for:

• unexplained headaches of recent onset:
  • present for at least 1 month
  • not accompanied by features suggestive of raised intracranial pressure.

Reference:

1. NICE (June 2005). Referral Guidelines for Suspected Cancer