Primary cerebral nocardiosis is very rare and the subgroup of the isolate has usually been defined as Nocardia asteroides. We report an unusual patient with a cerebral abscess whose cultures were typical for N. nova. It was first isolated from an HIV-1 infected individual and has a distinctive antibiotic susceptibility among the species of N. asteroides. Aggressive surgical and medical intervention is a must for these unusual pathogens. Although our surgical strategy was successful, treatment of nocardial cerebral abscess is quite hard and long lasting, and N. nova in particular necessitates a specific antibiotic regimen.