Latero-basal fractures of the skull base due to a blunt head injury may cause vascular and nervous lesions. The most important lesion is rupture of the middle meningeal artery in the foramen spinosum leading to an acute epidural haematoma. Its early diagnosis is of vital importance. Lesions of the cranial nerves are rarely surgically remediable. Diagnostic steps in the management of these lesions are outlined. Close cooperation between ENT specialists and neurosurgeons is of the highest importance, particularly when dealing with petrous bone lesions producing C.S.F. otorrhea or the prolapse appearance of contused brain into the auditory canal.