Abstract: Brain damage in head injury results from either neural or vascular injury. Understanding the mechanisms of injury and their consequences is the foundation of management in head injured patient. This is a retrospective study of 216 cases with severe head injury that admitted and went under autopsy after death. From 216 cases, 81.9 were male and 18.1% female. The mechanism of trauma was traffic accident in 70.4%, falling in 18.8%, job accident in 6.1 and murder in 4.7%. Cases between 16-60 years old including 61.5% of all mortality. Cases whose death time was in 0-24 h after admission, consist of 27.7% of all mortality rate. The most common finding was linear skull fracture. Subdural hematoma was the most common extra axial lesion (45.4%). The most common intra axial lesion was contusion that was associated with skull fracture in 35.2%. The frequency of epidural hematoma was the same in all types of skull fractures. SAH was seen in 52.6% without any fracture.