A review of 905 consecutive cases of pathologically confirmed brain tumour yielded 25 cases in which the initial presentation strongly suggested the diagnosis of occlusive cerebrovascular disease. Most of these 25 patients were admitted through the emergency department of our hospital and referred to the general medical service for investigation. Nineteen cases of transient ischemic attack and six cases of completed stroke were found in 12 cases of glioblastoma, seven of meningioma, two of metastatic renal cell carcinoma, and one case each of malignant astrocytoma, low-grade astrocytoma, oligodendroglioma, and metastatic squamous cell carcinoma. We document the clinical overlap between neoplastic and vascular syndromes, and stress the need for "tumour awareness" in the work-up of patients presenting to non-neurological practitioners with the clinical picture of occlusive cerebrovascular disease.