A patient with an advanced adenocarcinoma of the ovary developed spontaneous central nervous system (CNS) bleeding as initial evidence of brain involvement by a tumor. The rarity of this phenomenon in patients with ovarian tumors is emphasized and the incidence and course of brain metastases in ovarian cancer are reviewed. Similar to previous reports, our patient had extra abdominal systemic disease at the time CNS involvement was diagnosed. Although good short-term results were achieved with whole-brain irradiation, the prognosis for these patients remains dismal. The incidence of brain metastases may increase in patients with advanced ovarian malignancies given the possibility of achieving long-term survival in a significant percentage of women with widespread disease being currently treated with intensive systemic chemotherapy.