Restless legs syndrome (RLS) is a well-de®ned symptom complex, occurring either as idiopathic RLS or in association with many other disorders. Although no de®nite etiology is known for this condition, several pathophysiological mechanisms have been proposed. There is supportive evidence that RLS is a central nervous system (CNS) dysfunction, suggesting involvement of the descending dopaminergic (DA) pathways, but it can also occur with spinal disorders. We present a patient su ering from RLS who eventually was diagnosed with a foramen magnum tumor. Based on the available evidence, we attempt to correlate the location of the tumor with the patient's symptoms of RLS.