Solitary brainstem abscess is uncommon condition with high mortality and morbidity. The diagnosis require high index of suspicion and appropriate imaging. It can be managed by medical treatment alone, stereotactic aspiration of the purulent material, or by surgical drainage along with medical therapy. Here, I present a case of a child with large solitary brainstem abscess involving the pons and the medulla oblongata without systemic infection or systemic predisposing factors. The patient managed by mean of microsurgical drainage and antibiotic therapy. The literatures on brainstem abscess was reviewed and an over view of the literature is presented. This case-based review of brainstem abscess reinforce the conclusion that early diagnosis and proper management with microsurgical drainage and maximal medical therapy may result in a good prognosis.