What are the key clinical features that should raise suspicion for a primary brain tumour in adults?

Key clinical features that should raise suspicion for a primary brain tumour in adults include:

• New onset or progressively worsening headaches, particularly if they are persistent, worse in the morning, or associated with nausea and vomiting.
• Focal neurological deficits such as weakness, sensory loss, visual disturbances, or speech difficulties that develop or worsen over time.
• Seizures, especially new onset in adults without a prior history of epilepsy.
• Cognitive or personality changes, including memory loss, confusion, or altered behaviour.
• Symptoms of raised intracranial pressure such as nausea, vomiting, and papilloedema on examination.
• Gait disturbance or coordination problems.

These features warrant urgent neuroimaging to exclude a brain tumour NICE NG99 (NG99; CKS). The clinical presentation can be subtle and variable depending on tumour location and size, so a high index of suspicion is necessary. The literature supports these features as common presenting symptoms and signs of primary brain tumours, emphasizing the importance of early recognition and diagnosis Newton 1994.