Including those in our 4 patients, there are a total of 38 reported cases of solitary abscess of the brainstem. The route of infection may be direct extension usually from suppuration from the middle ear or hemato-genous spread from a remote focus. In some instances, the route of infection is unknown. The clinicr.l picture often is complicated by the presence of basal meningitis or dural thrombophlebitis. The most frequent signs and symptoms described in all 38 patients were facial weak- ness, fever, headache, hemiparesis, dysphagia, and vomiting, but classical brainstem syndromes (that is, alternating cranial nerve and long tract signs) were present in only 11.