Concurrent supra and infra-tentorial traumatic parenchymal hematomas: Which one needs to be evacuated first?

Traumatic intra-cerebellar hematoma although uncommon, yet increasing recognized lesions accounting for 6-0.82% of the total hematomas. We discuss a case of 19-year-old male multiple simultaneous traumatic supratentorial and infra-tentorial hemorrhages. In present case presence of significant size hematomas in both supra and infra-tentorial compartment posed a difficult challenge as which one needs to be evacuated first? This was a concern in present case as evacuation of the infra-tentorial hematoma can lead to downward herniation and evacuation of the supratentorial hematoma can lead to upward herniation. The difficulties and approach for an uncommon case of delayed and multiple traumatic supra and infra-tentorial hematomas are discussed.