We report a 56-year-old man, with atypical presentation of an extradural hematoma caused by head injury after a fall. The presence of a temporal arachnoid cyst on the grounds of temporal lobe agenesis altered the clinical image of this man, causing only mild symptoms where an otherwise acute neurologic deterioration would be expected in the case of an epidural hematoma of such extent. The hematoma was evacuated through a left pterional craniotomy and a tear in the middle meningeal vein was recognized as the source of bleeding. Postoperative course was uneventful and the patient was discharged within 5 days. An extensive review of literature available to us revealed only 5 other such cases reported that all were younger patients.