Neurology 2WW

This guidance covers the referral of a patient who presents with symptoms suggestive of brain or CNS cancer to an appropriate specialist, depending on local arrangements.

Discuss any concerns about a patient's symptoms and/or signs with a local specialist. If rapid access to scanning is available, consider as an alternative to referral

Re-assessment and re-examination is required if the patient does not progress according to expectations

GPs can refer a patient they suspect of having cancer to be seen within 14 days by a specialist. GPs must send the referral within 24 hours of the decision to refer

Please use the referral forms listed on this page to ensure appropriateness. They have been agreed by the Peninsula Cancer Network.

Assessment

Refer urgently patients previously diagnosed with any cancer who develop any of the following symptoms:

  • recent-onset seizure
  • progressive neurological deficit
  • persistent headaches
  • new mental or cognitive changes
  • new neurological signs

Investigations

In a patient with new, unexplained headaches or neurological symptoms, undertake a neurological examination guided by the symptoms, but including examination for papilledema. Note that the absence of papilledema does not exclude the possibility of a brain tumour.

When a patient presents with seizure, take a detailed history from the patient and an eyewitness to the event. Carry out a physical examination, including cardiac, neurological and mental state, and developmental assessment, where appropriate.

Referral

Referral Instructions

The GP should: use the e-Referral Service to book the appointment where this service is available

  • Specialty: 2WW
  • Clinic Type: 2WW Brain
  • Service selection: DRSS-Western-2WW Brain and CNS-NHS Devon CCG-99P

Refer patient urgently with:

  • symptoms related to the CNS, including:
    • progressive neurological deficit
    • new-onset seizures
    • headaches
    • mental changes
    • cranial nerve palsy
  • unilateral sensor neural 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)
  • 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 the other symptoms and signs of a brain tumour.

Refer urgently patients previously diagnosed with any cancer who develop any of the following symptoms:

  • recent-onset seizure
  • progressive neurological deficit
  • persistent headaches
  • new mental or cognitive changes
  • new neurological signs

Consider non-urgent referral or discussion with specialist for:

  • unexplained headaches of recent onset:
  • present for at least 1 month
  • not accompanied by features suggestive of raised intracranial pressure

Referral Forms

Suspected Brain & CNS cancer referral form - No Merge fields

Suspected Brain & CNS cancer referral form - Emis WEB

Suspected Brain & CNS cancer referral form - Microtest

Suspected Brain & CNS cancer referral form - Systmone with Problems Merge field

Suspected Brain & CNS cancer referral form - Systmone with Summary Merge field

 

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