STEP 2: Presentation, initial investigations and referral

Signs and symptoms

While symptoms are often non-specific, investigate the following signs and symptoms:

  • increasing headaches, persistent new headaches, vomiting, unexplained morning headaches
  • seizures
  • blackouts or other alterations in conscious state
  • poor coordination
  • visual deterioration or other focal neurological symptoms
  • progressive weakness
  • change in behaviour
  • change in memory
  • confusion, drowsiness
  • speech disturbance
  • other unexplained neurological symptoms including major personality/behavioural changes.

General practitioner

All patients who present with focal neurological symptoms, a first seizure or recurring headaches will require urgent neuroimaging and evaluation by a neurologist or neurosurgeon to establish the cause. If an initial CT scan of the brain is negative, but there is still a clinical concern, specialist referral and/or MRI should be performed urgently – posterior fossa and temporal lobe lesions or more infiltrative lesions may be missed on a CT scan. Repeat MRI imaging with gadolinium contrast in 4–8 weeks if symptoms do not resolve.

Many patients will present directly to an emergency department with a catastrophic new neurological problem or seizure and will require urgent neurosurgical evaluation.

Referral options

At the referral stage, the patient’s GP or other referring doctor should advise the patient about their options for referral, waiting periods, expertise, if there are likely to be out-of-pocket costs and the range of services available. This will enable patients to make an informed choice of specialist and health service.


The GP’s responsibilities include:

  • explaining to the patient and/or carer who they are being referred to and why
  • recommending the patient doesn’t drive until they have had a neurosurgical review
  • supporting the patient and/or carer while waiting for specialist appointments
  • informing the patient and/or carer that they can contact Cancer Council on 13 11 20.



If there is a high clinical suspicion of high-grade glioma, refer patients to an appropriate neurosurgeon affiliated with an MDT within 24 hours of the patient presenting with symptoms. Healthcare providers should offer clear routes of rapid access to specialist evaluation.