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FIGURE 113.1 Traumatic subdural hemorrhage. Axial noncontrast CT shows a
significant 6-mm SDH over the left hemispheric convexity with approximately 9 mm of
midline shift.

In contrast, the vascular injury causing epidural hemorrhage, typically the
middle meningeal artery or dural venous sinus, allows blood to transverse
the space between the dura and overlying bony surface. The accumulating
epidural blood is not able to transverse the dural attachments at the sutures
accounting for the lens-shaped biconvex appearance on radiographic
imaging ( Fig. 113.2 ). Venous bleeding may accumulate slowly and
account for the classic presentation of patients with epidural hematomas
with a period of lucidity followed by rapid clinical deterioration.