Table 2 NICE 2005 guidelines on specialist referral

Symptoms related to the CNS, including

▪ progressive neurological deficit

▪ new-onset/suspected recent onset seizures

▪ headaches

▪ mental changes

▪ cranial nerve palsy

▪ unilateral sensorineural deafness

in whom a brain tumour is suspected

Headache 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

Patients with rapid progression of:

▪ sub-acute 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

Patients with:

▪ unexplained headaches of recent onset: either present for at least 1 month, or not accompanied by features suggestive of raised ICP