Temporal lobe abscess is a rare complication of mastoiditis or other otogenic infections. Signs and symptoms are caused by tissue damage or displacement, and the presentation includes fever, headache, meningeal signs, and altered mental/sensory status. In the setting of acute mastoiditis, the rate of occurrence of a cerebral abscess is very rare, and therefore poses a diagnostic challenge for the physician. Here, a case of temporal lobe abscess is presented, and radiological findings, surgical treatment, and outcome are discussed.