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Hypothermia is relatively a common condition and most cases involve mild hypothermia. But severe hypothermia below 30。C is medical an emergency condition. We report the case of a 41-year-old man who had been left in a manhole for more than 9 hours on a freezing cold water. He was transported to our emergency room in semicomatose state with a body temperature 26.5。C The patient was warmed with active rewarming. After initial stabilization, the patient was taken for a brain computed tomography and found to have large fronto temporo-parietal(FTP) subdural hemorrhage. The patient underwent an emergent decompressive craniectomy and hematoma evacuation. After surgery, he recovered to drowsy mentation and vital signs were stable.