|Persistent headache in AYAs requires a neurological examination by the GP.||D|
|AYAs presenting with recurrent headache and vomiting that cause early morning waking or occur on waking (signs of raised intracranial pressure) should be referred immediately to a specialist.||C|
The presence of any of the following neurological symptoms and signs in AYAs should prompt urgent or immediate referral:
|An AYA presenting with a reduced level of consciousness requires emergency admission.||C|
Symptoms and signs
Brain and central nervous system (CNS) tumours should be suspected in adolescents and young adults (AYAs) presenting with persistent or recurrent headache and vomiting, new-onset seizures or fits, cranial nerve abnormalities (e.g. palsy), visual disturbances (e.g. dysconjugate eye movements), gait abnormalities, motor or sensory signs (e.g. limb weakness, loss of coordination, deafness, vision problems), deterioration in intellectual capacity (e.g. unexplained deteriorating school performance or developmental milestones) and behavioural and/or mood changes (e.g. change in personality, irritability). Bladder and bowel disturbances may also be present.
Most AYAs presenting with headaches do not have brain cancer and the risk from an isolated headache does not warrant investigation. However, persistent headaches require a neurological examination by the general practitioner (GP).
The risk of headache due to brain cancer increases with the following factors: presence of vomiting, ‘non-tension’ type pain, and headache present for less than ten weeks; headache combined with vomiting is the most common combination. AYAs presenting with symptoms of brain or CNS tumours should be referred to a specialist; patients with recurrent headache and vomiting that cause early morning waking or occur on waking (signs of raised intracranial pressure) should be referred immediately.
Emergency department admission is required for AYAs presenting with a reduced level of consciousness.
Brain and CNS tumours are known to be related to previous exposure to ionising radiation in AYAs. Genetic disorders such as neurofibromatosis, Li-Fraumeni syndrome, tuberous sclerosis, nevoid basal cell syndrome and Turcot syndrome, male gender and Caucasian race have also been associated.
However, brain and CNS tumours can occur in AYAs without any of these risk factors.
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