Introduction: Tension Pneumocephalus is a rare but a life threatening neurosurgical emergency which may need urgent surgical intervention. For diagnosis Brain imaging preferably Brain CT scan is mandatory. Case presentation: We present a rare case case of post traumatic tension Pneumocephalus in 40 years old man who sustained a road traffic accident. Brain CT scan shows Mount Fuji sign and air bubble sign, which are the typical signs of tension Pneumocephalus. Emergency burr-hole evacuation was carried out and after the procedure the patient was followed by control lateral skull X-ray and then discharged after 10 days of hospital Stay with GCS of 15. Conclusion: Tension Pneumocephalus is a clinical diagnosis. History with Brain Imaging can easily diagnose it but invasive surgical intervention may be Mandatory to overcome the problem. Knowledge of risk factors ,radiographic findings and clinical signs/symptoms associated with Tension Pneumocephalus is crucial to its Prompt identification and treatment.