A case of intracranial epidermoid cyst with intracystic hemorrhage is reported. A 63-year-old woman sustained a head injury after a fall; obtundation and ataxia were noted later. Computed tomography revealed a heterogeneous hyperdense lesion in the posterior and middle cranial fossas. Magnetic resonance imaging showed a lesion with increased signal intensity both on T1 and T2 weighted images. Two craniotomies revealed an intracranial epidermoid cyst with about 6 mL of clotted blood. Pathologic study showed hemosiderin-laden macrophages and neovascularity in the cystic wall granulation tissue, which indicated rupture of the cystic wall with intracystic hemorrhage, which later correlated with the diagnostic image findings. The patient tolerated the two operations well and her postoperative course was smooth. She was discharged in good health without obvious neurologic deficits.