Background: Epidural hematoma (EDH) is not uncommon in our locality (Sohag governorate) and its incidence is progressively increasing due to the growing incidence of road traffic accidents (RTAs) in Egypt, the high incidence of assaults and falling from height. Bone flap evacuation is the classic standard treatment of epidural hematomas as it is a neurosurgical emergency to control bleeding and remove blood clots. However, the conservative treatment is an option for treatment in some cases. Brain Trauma Foundation put the rules and indications of the conservative treatment in 2006. Since then, no sharp lines guide the physicians to take decision who to be treated conservatively and who to be treated surgically. Our aim in this study is to report patients who underwent a conservative treatment and their follow-up data and to detect the predictors behind the success of the conservative treatment. Patients & method: A retrospective study was applied to patients in the emergency department in Sohag university hospital in 4 years from April 2008 to April 2012. Demographic data, the level of consciousness, neurological assessment and radiological findings were reported. Results: Out of 33 patients involved in this study, the mean age was 26.3 ± 5.9 years. Only 18% required surgical intervention. The RTAs was the most common cause by 63%. All of them were initially treated conservatively. Conservative treatment was enough in 27 patients (82%). No deaths were reported in both groups and 30 patients (90.9%) were discharged to home with better neurological status. Conclusion: Many small epidural hematomas could be managed conservatively with an excellent outcome. Conversion to operative intervention carries no risk on patient’s clinical picture. The center must have the abilities of equipped radiology and operative room in case of neurological worsening.