Background: Brain abscess is a serious disease in the central nerve system with high rates of mortality and neurologic impairment in pediatric patients. We performed a study to summarize the clinical manifestations and outcome in children with brain abscess at a tertiary medical center. Methods: A retrospective review was performed in pediatric patients who were diagnosed with brain abscess for 15 consecutive years from January 1994 to June 2009. The medical records were collected from the chart review. Results: Twenty-five patients were diagnosed with brain abscess. On average 1.67 episodes per year were identified. The median age was 4.3 years (range, 0.1-18.9 years). The male to female ratio was 1.3:1 (14 males, 11 females). The common presenting clinical manifestations were fever (18/25, 72%), seizure (12/25, 48%), changed mental status (11/25, 44%), signs of increased intracranial pressure (9/25, 36%), and focal neurologic deficits (7/25, 28%). Predisposing factors were identified in 15 patients (15/25, 60%). The common predisposing factors were otogenic infection (3/15, 12%) and penetrating head trauma (3/15, 12%) followed by preceding meningitis (n=2), neurosurgical procedure (n=2), endocarditis (n=2), ventriculoperioneal shunts (n=2) and poor oral hygiene (n=1). A total of 14 (56%) patients had underlying illnesses, congenital heart disease (8/25, 32%) being the most common cause. Causative organisms were identified from abscess culture (n=5), blood culture (n=6), CSF culture (n=4) or pathologic report (n=2) in 60% of patients (15/25 patients); S. intermedius (n=3), S. aureus (n=3), S. pneumoniae (n=1), Group B streptococcus (n=2), E. coli (n=1), P. aeruginosa (n=1), and suspected fungal infection (n=5). Nine patients received medical treatment only while other 16 patients also required surgical intervention. Overall mortality rate was 16% (4/25 patients) and 24% of patients (5/21) had neurologic sequelae. Conclusion: Although uncommon, brain abscess is a serious disease and a high level of suspicion is very important for the early diagnosis of brain abscess.