This study included 11,111 cases with confirmed primary brain tumors reported by 679 different hospitals in the United States in 1980 and in 1985. The combinations of symptoms and signs in relation to the site of the brain tumors, supratentorial vs infratentorial, were studied. Only one symptom was present in 32.9% and 26.7% of cases with supratentorial and infratentorial tumors. No neurologic sign was detected at the time of diagnosis in 20% and 14.6% of cases with supratentorial and infratentorial tumors, respectively. Considering the clinical stage at diagnosis, no neurologic sign was detected in 21.4% of patients presenting in stages I and II: compared with 11.5% in those presenting in late clinical stages (III & IV). The study confirmed the importance of meticulous history taking for early referral for diagnosis of brain tumors.