Evaluation of intracranial neoplasms in the geriatric population needs consideration as the incidence of these neoplasms has increased much faster in the elderly than in their younger counterparts due to increased life expectancy. The spectrum of presenting symptoms among the elderly is distinctly different and considerably more diverse than for younger patients. Elderly patients are more likely to experience a variety of other symptoms, such as confusion, aphasia, memory loss, and personality change, besides focal motor weakness. Many of these symptoms may be easily confused with the normal signs of aging. The major differential diagnosis is cerebrovascular disease, and imaging plays a crucial role in its differentiation. Incidence of tumor type also shows significantly different patterns in the geriatric age group than in younger patients. Glioblastoma is more common than other primary neoplasms in the brain, and extradural lesions such as vertebral metastases are more common than intramedullary lesions in spine. In this population, benign lesions, e.g., acoustic schwannoma or typical meningioma, should be managed conservatively unless their symptoms warrant aggressive management. Magnetic resonance imaging (MRI) is the investigation of choice as it resolves many of the issues related to management, such as defining the nature and extent of the lesion and its associated complications. With the use of advanced MRI techniques such as diffusion-weighted imaging, diffusion tensor imaging, perfusion imaging, MR spectroscopy, and recent addition of texture analysis and amide transfer proton MRI, it may be possible to make a precise diagnosis of central nervous system neoplasms.