Case Report: A 74-year-old man with tobacco use presented with head trauma following a fall while climbing down a ladder. Initial computed tomography head (CTH) showed multifocal sub-centimeter bilateral parenchymal hemorrhages and scattered traumatic subarachnoid hemorrhages. With a normal neurologic examination and a stable repeat CTH, he was discharged home. 25 days later, he presented with acute onset left-sided arm and leg weakness. CTH was consistent with large right frontoparietal parenchymal hemorrhage with associated edema, subdural hematoma, subarachnoid and intraventricular extension, along with a 5 mm leftward midline shift at the level of cingulate gyrus. Angiogram of the head was unremarkable for underlying malformations. Magnetic resonance imaging of the brain was unremarkable for an acute infarction, mass or cerebral amyloid angiopathy. He was diagnosed with delayed posttraumatic acute intracerebral hemorrhage.