Science and Education Publishing American Journal of Medical Case Reports ISSN Pending 2 1 2014 01 16 A Rare Presentation of Acute Coronary Syndrome with Posterior Fossa Intracranial Bleed 10 11 EN Shazia Yasir ER Physician (PG), Ziauddin University Hospital AJMCR2014213 10.12691/ajmcr-2-1-3 2013 11 09 2013 12 29 2014 01 16 Without significant coronary artery stenosis, ischemic ECG changes including ST segment elevation, segmental wall abnormality & elevated serum cardiac specific markers may develop after central nervous system injuries. Misdiagnosing these patients as acute MI may result in catastrophic outcomes. By reporting case of 56 year old male with posterior cranial fossa haemorrhage mimicking ST segment elevation MI, we hope to underline that careful attention to neurological abnormalities is critical in making correct diagnosis.