Snapshot A 28-year-old snow skier strikes a tree and was not wearing a helmet. He loses consciousness for several minutes but later regains consciousness and reports feeling fine. Several hours later his neurological state decompensates acutely. His CT scan is shown. Introduction A traumatic intracranial hemorrhage following temporal bone skull fracture resulting in tearing of the middle meningeal artery the middle meningeal artery passes through the foramen spinosum of the sphenoid bone Resultant rapid expansion of the hematoma with high arterial pressure can lead to transtentorial herniation Presentation Symptoms momentary loss of consciousness lucid period up to 48 hours headache, nausea, hemiparesis Physical exam CN III palsy (if tentorial herniation present) Evaluation CT lens-shaped, biconvex hyperdensity not crossing sutures Differential Subdural hematoma, subarachnoid bleed Treatment Surgical evacuate hematoma Medical management of increased intracerebral pressure mannitol hyperventilate steroids/ventricular shunt Prognosis, Prevention, and Complications Prognosis better than for subdurals