How should I approach the referral process for a patient with suspected brain tumour symptoms, including the necessary imaging studies?

Referral Process for Suspected Brain Tumour:

• For adults presenting with progressive, sub-acute loss of central neurological function suggestive of a brain tumour, consider an urgent referral for a direct access MRI scan of the brain, or a CT scan if MRI is contraindicated, to be performed within 2 weeks.
• For children and young people with newly abnormal cerebellar or other central neurological function, consider a very urgent referral for specialist assessment, aiming for an appointment within 48 hours.
• If there is uncertainty about symptom interpretation or referral necessity, discuss the case with a specialist (e.g., via telephone or email) to communicate concerns and urgency.
• Ensure referral letters include all relevant clinical information and specify whether the referral is urgent or non-urgent, using local referral proformas if available.
• Make the referral within 1 working day once the decision is made.

Imaging Investigations:

• Offer standard structural MRI (including T2 weighted, FLAIR, DWI series, and T1 pre- and post-contrast volume) as the initial diagnostic test for suspected glioma or brain tumour unless contraindicated.
• If MRI is contraindicated, a CT scan may be used as an alternative.
• Consider advanced MRI techniques such as MR perfusion, diffusion tensor imaging, and MR spectroscopy if standard imaging results are unclear or to assess tumour grade.
• Refer patients with suspected glioma to a specialist multidisciplinary team at first radiological diagnosis for management.