Prior to discharge from the Cornell Equine Hospital, a 4 month old Standardbred colt was found recumbent with epistaxis. On standing, the colt was obtunded and later began circling and head pressing. His left eye was swollen and abraded. He later developed seizures. A neurological lesion was localized to the left forebrain though one episode of cerebellar signs suggested cerebellar involvement. Head magnetic resonance imaging (MRI) revealed multifocal lesions including a large poorly-marginated left frontal lobe lesion. Cerebrospinal fluid analysis revealed a neutrophilic pleocytosis. Given the multifocal nature of the lesions and the colt’s history of aspiration pneumonia and orthopedic infection, an infectious etiology was prioritized. The colt continued to experience seizures despite aggressive therapy and was euthanized. The post-mortem examination revealed a left frontal lobe infarct, with multiple smaller infarcts. There was no evidence of a septic event on histopathology. This report details the management of intracranial disease and seizures in a foal.