A 35-year-old man with a past medical history significant for Chiari malformation and pulmonary embolism (PE) treated with Xarelto presented after an 8-foot fall from a loading dock. The patient was noted to have a large left forehead hematoma and a seizure of five seconds' duration noted by EMS prior to arrival. His Glasgow Coma Scale (GCS) score was 15, and his Focused Assessment with Sonography in Trauma (FAST) exam was positive.