One of the greatest improvements in outcome for patients with head injury has resulted from the earlier identification of patients at risk for intracranial haematoma. The presence of a skull fracture, particularly in conscious patients, is associated with a much higher risk of haematoma. Computerized tomography scanning of these patients will probably lead to earlier detection. While there is great enthusiasm for aggressive treatment and intensive care management, it is difficult to show that this improves outcome significantly. That is not to say that aggressive resuscitation and prevention of hypoxia and hypotension will not lead to a reduction in secondary ischaemic brain damage.