Focal intracranial infections are relatively rare, but the consequences of a missed or delayed diagnosis are significant. The clinician is urged to consider these diagnoses in patients with headaches or focal neurologic examinations, particularly in the setting of known or suspected otorhinologic disease. For diagnosis, gadolinium-enhanced MR imaging or MR imaging with angiography are the procedures of choice; CT is far less sensitive and specific. Lumbar puncture is contraindicated in most of these infections. Management of suspected elevation of intracranial pressure and broad empiric antibiotic therapy should be instituted emergently. Early involvement of surgical services is recommended.