"Faith" is a fine invention When Centleman can see— But Microscopes are prudent In an Emergency

EMILY DICKINSON, 1891

This article discusses four focal intracranial infections that, if unrecognized or not treated promptly, are associated with a high morbidity and mortality: brain abscess, subdural empyema, intracranial epidural abscess, and septic thrombophlebitis of the dural venous sinuses. Presentations range from insidious to fulminant, some with a classic constellation of symptoms and signs, others more subtle. All require clinical vigilance. Emphasis is placed on syndrome recognition, timely evaluation, differential diagnosis, empiric antibiotic therapy, and management of elevated intracranial pressure.