Scottish referral guidelines for suspected cancer: quick reference guide

Brain/Central Nervous System Tumours

Neurological Deficit

• Subacute progressive neurological deficit (including personality or behavioural change) in the absence of previously diagnosed or suspected alternative disorders.

Seizure

New onset seizures characterised by one or more of the following:

• Focal seizures.
• Significant post-ictal focal deficit (excluding confusion).
• Epilepsy presenting as status epilepticus.
• Associated inter-ictal focal deficit.
• Associated preceding persistent headache of recent onset.
• Seizure frequency accelerating over weeks or months.

Headache

• Headache with vomiting and papilloedema.
• Consider urgent referral for patients with non-migrainous headaches of recent onset, when accompanied by features suggestive of raised intracranial pressure (e.g. woken by headache; vomiting; drowsiness), progressive neurological deficit or new seizure.

The probability of having a brain tumour in the following situations is as follows:

• New onset seizure (any type) in adults 2-6%
• New onset status epilepticus >10%
• Chronic daily headache, without features of raised intracranial pressure <1%