Generally, according to international literature, cerebral ischemia is a secondary posttraumatic lesion produced by direct compression in the context of a cerebral herniation syndrome or indirect by vasospasm produced by posttraumatic subarachnoid, subdural or intraventricular hemorrhages. We present the case of a patient with an acute MCA ischemia with severe head injury due to a fall with subsequent intracranial acute intracerebral and subdural hematoma which evolved with acute left uncal, parahipocampal and subfalcinecerebral herniation (coma, GCS 6, left mydriasis, right severe hemiparesis). Surgical emergency aspiration of the hematomas was performed. Postoperative treatment of cerebral ischemia and residual hematomas was properly done. We consider important and underdiagnosed the association of cerebral ischemia and secondary posttraumatic brain injuries. Abbreviations: MCA-middle cerebral artery, GCS-Glasgow Coma Scale, ICA-internal carotid artery, PCA-posterior cerebral artery, ACA-anterior cerebral artery. Conclusion: We present a case of a patient with an acute MCA ischemia with secondary head injury due to a fall with subsequent intracranial acute intracerebral and subdural hematomas. Surgical emergency aspiration of the hematomas was performed. The treatment was performed for both lesions (cerebral ischemia and posttraumatic hematomas) with vitamins B, neurotrophycs, pain killers, antibiotics. Unfortunately, due to aggravation of the Mendelson syndrome, the patient died 7 days later.