A previously healthy 5-year-old male castrated Domestic Shorthair cat presented to the Cornell University Hospital for Animals’ Neurology Service following referral for evaluation of neurological signs. The patient was initially presented to the referring veterinarian for inappetence and “dragging” of the right hind limb. The referring veterinarian noted a right-sided head tilt, absent menace response in the right eye, and postural reaction deficits in the right thoracic and pelvic limbs. Complete Blood Count and Chemistry disclosed a mild hyperproteinemia. The patient was referred to Cornell for further investigation of his neurologic signs. On presentation to the Cornell Emergency Service, the patient was bright, alert, and responsive with normal vital parameters. Physical examination confirmed the abnormalities noted by the referring veterinarian and also disclosed a right sided ear droop and moderate brown discharge in the right ear which contained cocci on ear cytology. Full neurological examination revealed a right sided head tilt, absent menace response in the right eye, increased extensor tone in the right thoracic and pelvic limbs, right-sided postural reaction deficits, and pain on palpation of the head. The patient’s clinical signs neurolocalized to the left forebrain and right vestibular system. An MRI revealed meningoencephalopathy with multifocal intra-axial left forebrain lesions and patchy cerebral and brainstem meningeal enhancement, as well as right otitis media with a possible polyp. Cerebrospinal fluid analysis showed a mixed cell pleocytosis, consistent with inflammation possibly secondary to infection. Extension of otitis media/interna into the cranial cavity was prioritized as the primary differential. The patient underwent right ventral bulla osteotomy and was placed on antibiotics. Ventral bulla biopsy samples were submitted for culture and histopathology. This presentation will discuss the presentation, diagnosis, and treatment of otitis media/interna with intracranial involvement in this patient.