Table 2 (From 2005 guidelines [3])

Refer urgently patients with:

 • symptoms related to the CNS, including:

  - progressive neurological deficit

  - new-onset seizures

  - headaches

  - mental changes

  - cranial nerve palsy

  - unilateral sensorineural deafness

    in whom a brain tumour is suspected

 • 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)

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 other symptoms and signs of a brain tumour