||The Middle Pleistocene Homo erectus cranium from Hexian (Hexian 1, PA 830), in central eastern China, has been studied fairly extensively with respect to its evolutionary position. However, analysis of a series of neurocranial abnormalities identified on the Hexian fossil has never been attempted. Here, we present the first study of these abnormalities identified on the Hexian cranium, including (1) multiple breakages (including cracking) that fracture radially across the whole vault, caused by taphonomic modifications; (2) postmortem erosional lacunae with a matrix layer on the external surface of the supraorbital torus; (3) and two healed lesions with resorption and new bone formation on the back of the head, likely the result of trauma (tensile trauma to the scalp or partial scalp removal) or burning (with damage to the scalp and superficial neurocranium). The Hexian 1 individual was a young adult and had experienced multiple neurocranial alterations of antemortem traumatic lesions and postmortem taphonomic damage. The Hexian 1 specimen adds to the growing list of examples of bone surface modifications on Pleistocene hominin fossils across the Old World—a list that documents clearly the high level of risk experienced by Middle Pleistocene hominins.