Purpose: Patients with orbital wall fractures (OWF) may have serious associated injuries, which include intracranial and ocular injuries that require emergent management. We should use as our guideline to investigate the frequency of OWF with intracranial hemorrhage and the computed tomography findings. Method: We retrospectively reviewed the patients with OWF, who visited in emergency department of Asan Medical Center between January, 2004 to march, 2014. We compared mechanisms of injury, clinical presentation and types of fracture between patients with and without intracranial injury, those variables were analyzed by chi-square tests. Also, those variables significantly associated with the occurrence of the intracranial injury in patients with OWF were selected and their odds ratio and 95% confidence interval were calculated using logistic regression analysis. Result: Of the 421 patients, brain CT was performed for 296 (70.3%) patients with OWF, and 53 (12.6%) had intracranial injury. Although none of the clinical presentation showed significant difference between the subgroups, mechanisms of injury and types of fracture were statistically significant. In multivariate analysis, age (OR 1.03, 95% CI 1.01-1.05), violence (OR 6.20, 95% CI 2.81-13.7), and fall down (OR 8.37, 95% CI 3.13-22.42) were predictive of intracranial injury associated with OWF. The patients diagnosed OWF with brain injury had a lots of cases accompanied by other facial bone fractures, specially maxillar (43.4%), zygoma (34.0%), and nasal bone (34.0%) Conclusion: OWF associated intracranial injury is not a rare case in our study. Thorough history taking and physical examination are necessary to evaluate patients who may have orbital fractures. The results of our study could assist physicians to make decision to perform brain CT or not.