All patients who present with focal neurological symptoms, a first seizure or new onset or recurrent headaches will require urgent neuroimaging and evaluation by a neurologist or neurosurgeon to establish the cause of these symptoms. If an initial CT scan of the brain is negative, but there is continuing 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 four to eight 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.