Abstract: Objective To report the diagnosis and treatment of a patient with exertional heat stroke accompanying acute brain injury. Methods Clinical data (including clinical manifestations, imaging diagnosis, clinical treatment and its effciency) about a patient with exertional heat stroke accompanying acute brain injury were retrospectively analyzed with its related literature reviewed. Results The patient was a 18 years old male soldier. He was admitted to our hospital due to fever accompanying loss of consciousness after strenuous exercise and diagnosed as exertional heat stroke according to his medical history and laboratory testing. He was fnally diagnosed as acute brain injury according to his clinical manifestations and imaging fndings after admission. His laboratory test became almost normal and his consciousness was recovered, basic communication was possible with him, and his myodynamia was improved after active cooling, continuous bedside blood purification, hyperbaric oxygen therapy (HBOT) and expectant supportive treatment. Conclusion Clinical manifestations and early imaging findings of exertional heat stroke accompanying acute brain injury contribute to its diagnosis and treatment.