Dysphagia is a common problem in patients with neurologic disease and is often associated with significant morbidity and mortality. To evaluate primary brain tumor patients who complained of dysphagia, we adapted grading scales for severity of complaint and level of alertness (scale of 1 to 4) and bedside swallowing assessment and videofluoroscopic examination (scales of 1 to 5). Over 13 months, we prospectively screened 117 patients for dysphagia. Seventeen of these (14.5%) complained of dysphagia (mean age, 50.2 years; range, 20 to 75); an additional six control patients were studied from a group with no dysphagic complaints. Scoring for severity of complaint (mean, 2.3) and level of alertness (mean, 2.2) was mild-moderate in the majority of patients. Eleven of 17 patients scored > or = grade 3 (mean 3.2, moderate impairment, requiring supervision) on bedside testing, and six of seven scored > or = grade 3 (mean 3.8, moderate-moderately severe abnormality, trace or frequent aspiration) during videofluoroscopic evaluation. Bedside testing scores of the study group differed significantly (p < 0.001) from those of the control group. Level of alertness correlated strongly with bedside (r = 0.794) and videofluoroscopic (r = 0.780) scoring. Primary brain tumor patients with dysphagia are likely to have impairment of swallowing out of proportion to their complaints and therefore are at risk for aspiration and nutritional compromise. We recommend that these patients undergo formal swallowing assessment followed by rehabilitation or implementation of alternative feeding methods.