Snapshot A 69-year-old male with atrial fibrillation on warfarin had a syncopal episode and struck his head on the stairs. Shortly thereafter, he because unconsious. Introduction Occurs with head trauma + / - coagulopathy. Results from rupture of corical bridging veins. Especially common in elderly and alchoholics. Presentation Symptoms may begin from days to weeks after trauma. headache contralateral hemiparesis May look like a chronic change, with a past history of a fall: may be easily confused with dementia. Other focal changes. Evaluation CT shows crescent shaped, concave hyperdensity that can extend across suture line Treatment Evacuate hematoma via burr holes For increased ICP mannitol hyperventilate steroids / ventricular shunt Prognosis, Prevention, and Comlications Prognosis worse than epidurals due to concurrent brain damage.