A well-enhanced extra-axial meningioma over right frontal parasaggital region was incidentally found in this 53-year-old male. There was no neurological defi cit. Right frontal craniotomy with removal of tumor was smoothly performed under general anesthesia. Unfortunately, contralateral anisocoric pupil size was found right after the operation. CT scan of Brain showed contralateral acute SDH with mass effect and uncal herniation. Subsequent craniotomy on the other side was carried out for decompression. Literatures about postoperative intracranial hemorrhage have been reviewed and discussed 1,2,3, but remote site acute SDH is rare. We report this rare case and discuss about possible pathophysiology.