Although electrical burns account for a small portion of all thermal injuries, their treatment becomes more complex when associated with injuries of other organs. From July 1987 through December 1991, 8 of 249 burned patients sustained electrical burns associated with head injuries. The mean total body surface area burned was 19% (range, 2%-45%). Computed tomographic (CT) scans of the brain revealed that six patients with moderate to severe head injuries had intracranial hemorrhage including three cases of intracerebral hematoma and another three cases of epidural hematoma. Half of these patients underwent surgical intervention for removal of intracranial hematomas and a compound depressed fracture segments of the skull, and the others were treated conservatively. All the patients progressively recovered consciousness with Glasgow Coma Scale scores of 14 or more and minimal neurologic sequelae. The combination of early detection and prompt removal of life-threatening intracranial hematomas with aggressive support of electrical victims who appear dead would minimize the morbidity and mortality in patients with electrical burns and head injuries.