Isolated brainstem abscess, specifically, medullary abscess, is rare and often fatal. Diagnosis requires appropriate imaging and a high degree of clinical suspicion. Good outcomes are possible. A 69-year-old woman presented with an isolated medulla oblongata abscess that manifested as a syndrome of rapidly progressive multiple cranial nerve palsies and decreased level of consciousness. Microneurosurgical incision and drainage of the medullary abscess were performed. Maximal therapy of antibiotics, intensive care management, and extended rehabilitation was delivered. A prompt diagnosis of medullary abscess, with immediate microneurosurgical intervention and maximal medical therapy, may result in a good outcome.