Brain and Central Nervous System Cancers

Emergency (same day) referral

Urgent suspicion of cancer referral

• Neurological deficit:
  • Progressive neurological deficit (including personality, cognitive or behavioural change) in the absence of previously diagnosed or suspected alternative disorders (such as multiple sclerosis or dementia)

• Seizure:
  • Any new seizure
  • Seizures which change in character such as post–ictal deficit, headache, increased frequency, etc.

Good practice Points

• Consider urgent investigation/referral for patients with non-migrainous headaches of recent onset, when accompanied by “red flag” features suggestive of raised intra cranial pressure (for example: woken by headache; vomiting; drowsiness), progressive neurological deficit or new seizure disorder
• All NHS Boards have pathways for investigation of headaches which should include primary care direct access to imaging
• If any uncertainty about the presence of papilloedema, the person should be urgently referred to an optometrist for assessment. If there are red-flags suspicious of cancer as detailed above, a simultaneous
  urgent suspicion of cancer referral to secondary care should be made. If papilloedema is confirmed, the optometrist should refer directly to secondary care
• An urgent, suspicion of cancer pathway should exist in all NHS Boards for optometrists to refer directly to secondary care for people with optic discs suspicious of papilloedema