The patient was transferred urgently from the operating theater of Islamic hospital to the Shmaisani hospital at 1.30 A.M. after suffering falling down during epi-attack at 17.00 P.M. 04-September-2012. The patient is a known epileptic for 15 years under treatment with Epanutin 100 mg twice with occurrence around 1-2 per year. The patient was seen in the emergency with drowsiness and left sided paresis with impending conning. CT-scan done 3 hours ago showing fracture of the right temporal bone with 2 separate hematomas the major occupying the right middle fossa and the other in the right parietal region. GCS was 7/15. The patient was not obeying the verbal command.

The patient was taken urgently to the operating room and right temporo-parietal approach was done with reflection of the flap. There were several fracture lines, which were respected to preserve the integrity of the bone flap to prevent its fragmentation. The hematomas were removed and the still active bleeding branches of the right middle meningeal artery were coagulated and strict heamostasis was achieved. The dura was intact and no tears or CSF leak was noted. Ready-vac drain was inserted to the right middle fossa and the bone flap was returned to its place.

Routine closure of the wound. Smooth postoperative recovery and the patient became more vivid and responding for verbal commands with slight agitation and good power of the left side. The patient kept in the ICU.

The patient has 2 acute extradural hematomas which is rare. The great shift of the mid structures and the pending conning is the cause of urgent intervention.