For adults, loss of central neurological function (progressive, sub-acute) should prompt consideration of an urgent, direct access MRI scan of the brain (or CT scan if MRI is contraindicated) to be done within 2 weeks, for suspected brain or central nervous system cancer NICE NG12.
For children and young people, newly abnormal cerebellar or other central neurological function should prompt consideration of a very urgent referral for specialist assessment within 48 hours for suspected brain or central nervous system cancer NICE NG12.
Additionally, for patients presenting with headache, the following features should prompt evaluation and consideration for further investigations and/or referral, as they may indicate a serious underlying cause including a brain tumour:
- New-onset neurological deficit NICE CG150.
- New-onset cognitive dysfunction NICE CG150.
- Change in personality NICE CG150.
- Impaired level of consciousness NICE CG150.
- Vomiting without other obvious cause NICE CG150.
- Headache triggered by cough, Valsalva manoeuvre, or sneeze NICE CG150.
- Headache triggered by exercise NICE CG150.
- Orthostatic headache (headache that changes with posture) NICE CG150.
- A substantial change in the characteristics of their headache NICE CG150.
- New-onset headache with compromised immunity (e.g., caused by HIV or immunosuppressive drugs) NICE CG150.
- Age under 20 years with a history of malignancy NICE CG150.
- A history of malignancy known to metastasise to the brain NICE CG150.