Obtain biopsy of the brain metastasis if primary is not identified.
Initiate diagnostics of cancer of unknown primary.
Findings suggestive of metastatic brain tumor.
Findings suggestive of primary brain tumor: Consult neurosurgery for diagnostic confirmation, e.g., via brain biopsy or resection.
Further testing depends on imaging findings.
CT head and neck with IV contrast: if MRI is not possible.
Gadolinium-enhanced MRI head: preferred.
Symptom onset in patients with primary brain tumors is usually insidious, while symptom onset in patients with brain metastases is typically acute or subacute.
Cognitive, behavioral, and personality changes.
Focal neurological deficits depending on tumor location, e.g., sensory deficits.
Other signs of elevated intracranial pressure (ICP), e.g., papilledema.
Headaches (especially with headache red flags ).
Suspect a brain tumor in patients with clinical features including:.
Obtain a thorough patient history and neurological examination.
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