[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [General pathology](https://durgical.com/en/general-pathology/) › [Central nervous system](https://durgical.com/en/general-pathology/areas/cns/) › Epidural vs subdural hematoma

# Epidural vs subdural hematoma

- Lesion

Epidural bleeds are arterial and fast, between skull and dura; subdural bleeds are venous and slower, under the dura.

Updated Nov 12, 2026

## Key points

- Epidural: middle meningeal artery, temporal bone fracture, lens-shaped (biconvex) collection that does not cross suture lines.
- Classic epidural course: brief loss of consciousness, a lucid interval of hours, then rapid decline.
- Subdural: torn bridging veins, crescent-shaped collection that crosses sutures but not the midline falx.
- Subdural risk: brain atrophy (older age, alcohol) stretches the bridging veins; anticoagulants; infants with abusive head trauma.
- Chronic subdural hematomas organise with granulation tissue membranes that can rebleed.

## What it is

Trauma can tear vessels in the layers covering the brain. An epidural hematoma usually comes from a torn middle meningeal artery under a temporal fracture and grows fast between bone and dura. A subdural hematoma comes from bridging veins between the cortex and the dural sinuses and collects more slowly under the dura; it is common in older adults, people who drink heavily and infants. Both compress the brain and can cause herniation.

## Structure

- Acute subdural: soft dark clot over the convexity, easily lifted from the arachnoid.
- Healing subdural: lysis of clot after about a week, granulation tissue grows from the dura within two weeks, and fibrous membranes form over months.
- The outer membrane is thick and vascular, the inner thin; fragile new vessels cause repeated bleeding.

## Step by step

- A blow fractures the temporal bone or the brain moves and stretches bridging veins.
- Blood collects: fast under arterial pressure (epidural) or slowly (subdural).
- The clot acts as a mass and raises intracranial pressure.
- Without drainage, the brain herniates; a subdural that survives organises into membranes.

## Epidural vs subdural hematoma

| Feature | Epidural | Subdural |
| --- | --- | --- |
| Vessel | Middle meningeal artery (arterial) | Bridging veins (venous) |
| [Space](https://durgical.com/en/conditions/epidural-haematoma/) | Between skull and dura | Between dura and arachnoid |
| [Shape on CT](https://durgical.com/en/conditions/subdural-haematoma/) | Biconvex, lens-shaped | Crescent along the hemisphere |
| Crosses sutures | No (dura is attached there) | Yes |
| Typical patient | Young adult with a temporal fracture | Older adult, heavy drinker, infant |
| Speed | Hours; lucid interval | Days to weeks; can be chronic |

## Clinical notes

- Epidural hematoma is a neurosurgical emergency; prompt evacuation usually gives a good outcome.
- Chronic subdural hematoma in older adults can look like dementia, with confusion and gait change.

## Memory aid

Epidural is the express: artery, lens, lucid interval. Subdural is the slow train: veins, crescent, older or drinking passengers.

## Test yourself

Think of the answer, then tap the question to see it.

## Which vessel usually causes an epidural hematoma?

The middle meningeal artery, torn by a fracture of the squamous temporal bone.

## Why does an epidural hematoma not cross suture lines?

The dura is firmly attached to the skull at the sutures, so the collection is limited to one bone.

## Why are older adults at higher risk of subdural hematoma?

Brain atrophy stretches the bridging veins, which tear with minor trauma.

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## Elsewhere in DurgiPedia

- [Abusive head trauma (shaken baby)](https://durgical.com/en/forensic-medicine/abusive-head-trauma/)

## Connections

## Related 3

- [Brain and spinal cord trauma](https://durgical.com/en/general-pathology/brain-and-spinal-cord-trauma/)
- [Cerebral edema, hydrocephalus and herniation](https://durgical.com/en/general-pathology/cerebral-edema-hydrocephalus-and-herniation/)
- [Hemorrhage: petechiae, purpura, ecchymosis, hematoma, and what blood loss does](https://durgical.com/en/general-pathology/hemorrhage-petechiae-purpura-ecchymosis-hematoma-and-what-blood-loss-does/)

## Related conditions 6

- [Epidural haematoma](https://durgical.com/en/conditions/epidural-haematoma/)
- [Subdural haematoma](https://durgical.com/en/conditions/subdural-haematoma/)
- [Traumatic brain injury](https://durgical.com/en/conditions/traumatic-brain-injury/)
- [Child maltreatment (physical abuse, abusive head trauma, neglect)](https://durgical.com/en/conditions/child-maltreatment/)
- [Alcohol use disorder](https://durgical.com/en/conditions/alcohol-use-disorder/)
- [Raised intracranial pressure and brain herniation](https://durgical.com/en/conditions/raised-intracranial-pressure-and-brain-herniation/)

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Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.

Sources: [Epidural Hematoma](https://www.ncbi.nlm.nih.gov/books/NBK518982/) (StatPearls (NCBI Bookshelf), 2026); [Subdural Hematoma](https://www.ncbi.nlm.nih.gov/books/NBK532970/) (StatPearls (NCBI Bookshelf), 2026).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/general-pathology/epidural-vs-subdural-hematoma/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/general-pathology/epidural-vs-subdural-hematoma/