Neuro-oncologic emergencies are a diverse group of disorders that occur frequently in patients with brain tumors and other types of cancer. The most common structural alterations that cause mental status changes are the presence of primary or metastatic brain tumors. Seizures are common in patients with primary and metastatic brain tumors. In patients with a diagnosed brain tumor, the most common cause for seizure activity is nontherapeutic or inadequate anticonvulsant levels. The most important predisposing factors for cerebrovascular disease in cancer patients are direct effects of tumors on blood vessels, tumor-induced coagulation disorders (hemorrhagic and thrombotic), and treatment-related injury to blood vessels. Focal neurological signs and symptoms are common in patients with brain tumors and other forms of neuro-oncologic disease. In patients with systemic or central nervous system cancer, back pain is often the first sign of a more virulent underlying neurological process.