Scottish referral guidelines for suspected cancer: quick reference guide

Scottish Referral Guidelines for Suspected Cancer is a quick reference guide for cancer referrals.

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.


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 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%
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