Cerebral abscess is a collection of immune cells, pus, and other material in the brain, usually from a bacterial or fungal infection which gets enclosed in a capsule to for a mass. Once the process of infection starts the abscess evolves through four radiological stages, which was first described by Enzmann et al in 1983, to finally end as a capsulated lesion. The morbidity and mortality from CA has decreased over the years with the advent of new antibiotics, earlier scans and timely surgical intervention. Medical management is indicated in CA with small abscesses, deep multiple abscess, if associated with meningitis, presence of shunt and any disease with contraindication for surgery. The surgical options include aspiration-either burr hole or stereotactic, open craniotomy and endoscopic procedure. The neurosurgeon must thus be aware that although antibiotics are effective in controlling the CA there are situations when surgery will be needed and hence close observation is mandatory during treatment for best results. With more experience with endoscopic techniques there will be hopefully less and less craniotomy for CA. This article discusses the recent developments in CA pathophysiology, microbiological profile and its management.