Delayed contralateral epidural hematoma is a rare but well-documented complication in patients following decompressive surgery for acute subdural hematoma. However, instances of delayed contralateral epidural hematoma with an overlying skull fracture before acute subdural hematoma evacuation have rarely been documented. In this report, we present the case of a 15-year-old girl with a left-sided acute subdural hematoma and right-sided skull fracture after sustaining a head trauma. Forty-nine minutes after the initial computed tomography scan, dilation of the right pupil occurred and a large delayed right-sided epidural hematoma was confirmed through a subsequent computed tomography scan. We review and discuss the possible mechanism.