The petrous apex is a pyramid-shaped structure formed by the medial part of the temporal bone. Margins of this region are formed by the bony labyrinth laterally and the petro-occipital suture medially. It is a region with multitude of important vascular and neural structures either passing through it and in close relation to it. This gives rise to a wide spectrum of possible pathologies. Clinical presentation of petrous apex lesions can be variable ranging from incidentally detected lesions (on scans done for other unrelated indications) to headache, ear pain, and cranial neuropathies. The V and VI cranial nerves are the most common cranial nerves affected by petrous apex lesions. MRI is more helpful in tissue characterization and thus is more useful for differential diagnosis of petrous apex lesions.