Malignant cerebral glioma is the most common adult primary brain tumour but surprisingly few studies report how patients with early symptoms present in primary or secondary care. A retrospective audit in south east Scotland found considerable variation in the referral of patients with primary brain tumours: only one quarter of 439 patients were initially referred directly to specialist centres.¹ This must relate in part to the way in which symptoms develop and the difficulty of distinguishing them from more common but less sinister problems. For example, a large case record review of initial symptoms experienced by 653 glioma patients presenting to the National Hospital for Neurology and Neurosurgery, Queen Square, London, between 1955 and 1975 found a relatively low prevalence of neurological problems such as epilepsy (38%), headache (35%), mental change (17%), and hemiparesis (10%); by the time of diagnosis the prevalences were 54%, 71%, 52%, and 43%, respectively.² Few studies focus on the accounts of patients and relatives. One qualitative interview study of 28 Swedish patients suggested that relatives noticed general changes including cognitive …