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Our work is about a 28-year-old man, admitted to the emergency room for a head trauma. A cerebral CT was performed who shows a biconvex sub-tentorial extra-axial collection spontaneously hyperdense suggesting an extra dural hematoma of the posterior cerebral fossa. The surgical evacuation found that it was an acute subdural hematoma (ASDH) (A,B). The ASDH is a subdural blood collection, complicating venous more than arterial bleeding. with male predominance and an age between 20 and 40. Most commonly supra tentorial, Sub tentorial location is rare it represents less than 5%. The clinic associate alteration of consciousness, signs of focusing, vegetative manifestations and epilepsy. The diagnosis is based on a CT scan which shows an extra-axial hyperdense collection with more or less associated lesions. After medical management the treatment is surgical, based on the removal of the hematoma by suboccipital craniectomy.