A 45-year-old man, with no previous co-morbidities, was brought to the emergency department with an alleged history of a road traffic accident 1 day back. He was riding a two-wheeler bike under the influence of alcohol and was hit by a moving car. The patient suffered from a loss of consciousness following the accident, with no history of vomiting. On examination, his Glasgow Coma Scale (GCS) was E2V2M5, with the right pupil 1 mm reactive to light and the left pupil 2 mm reactive to light. No lateralizing focal neurological deficits were present. No major external injuries were noted. Examination revealed HR (heart rate): 102/min, BP (blood pressure) at 90/60 mmHg, RR (respiratory rate) at 16/min, and SpO2(oxygen saturation) at 96% on room air. His non-contrast computed tomography (NCCT) head revealed multiple hemorrhagic contusions in the right frontal region, with surrounding perilesional edema causing a mass effect in the form of effacement of loco-regional sulcal spaces and the frontal horn of the right lateral ventricle, with a mid-line shift of about 4 mm to the left side (Fig. 38.1). Computed tomography (CT) spine, chest, and abdomen revealed no significant abnormality. His laboratory investigations revealed normal blood counts, renal function tests, and metabolic panel, but mildly raised liver enzymes, and an alcohol level of 47 mg/dl. He was intubated and put on mechanical ventilation. Injection of 20% mannitol was started along with levetiracetam.