Brain Hematoma vs Brain Hemorrhage: Key Differences, Symptoms, and Treatment

Hematoma vs Hemorrhage: What's the Difference?

The terms brain hematoma and brain hemorrhage are often used interchangeably, but they describe different stages of the same underlying problem: bleeding in or around the brain.

• A hemorrhage is the active bleeding itself — blood escaping from a damaged vessel into brain tissue or the surrounding space.
• A hematoma is the collection of blood that forms once that bleeding pools and clots, often pressing on the brain.

Put simply: every hematoma starts as a hemorrhage, but not every hemorrhage becomes a large, organized hematoma.

Types of Brain Hemorrhage

Hemorrhages are classified by where the bleeding occurs:

• Intracerebral hemorrhage (ICH): bleeding inside the brain tissue, usually from chronic high blood pressure.
• Subarachnoid hemorrhage (SAH): bleeding into the space surrounding the brain, most often from a ruptured aneurysm.
• Intraventricular hemorrhage: bleeding into the fluid-filled ventricles of the brain.

Types of Brain Hematoma

Hematomas are classified by which layer of tissue the blood collects under:

• Epidural hematoma: between the skull and the dura — typically from a skull fracture tearing an artery. Symptoms can progress rapidly.
• Subdural hematoma: between the dura and the brain — often from torn bridging veins after a fall, especially in older adults or patients on blood thinners.
• Intraparenchymal hematoma: a clot that has formed within brain tissue after an intracerebral hemorrhage.

Common Symptoms

Both conditions can cause:

• Sudden, severe ("thunderclap") headache
• Nausea and vomiting
• Weakness or numbness on one side of the body
• Slurred speech or confusion
• Vision changes
• Loss of consciousness or seizures

Any of these symptoms after a head injury — or with no clear trigger — is a medical emergency. Call 911.

How Neurosurgeons Diagnose Them

Imaging is the key:

1. Non-contrast CT scan — the first test in the ER; fresh blood shows up bright white.
2. MRI — used to age the bleed and look at the surrounding brain.
3. CT or catheter angiography — used when an aneurysm, AVM, or other vascular cause is suspected.

Treatment Differences

Hemorrhage management

• Aggressive blood pressure control
• Reversal of blood thinners when present
• Treating the underlying cause — for example, clipping or coiling a ruptured aneurysm in subarachnoid hemorrhage

Hematoma management

• Small, stable hematomas are often monitored with serial imaging in a neuro ICU.
• Large or expanding hematomas that compress the brain may need surgical evacuation — a craniotomy or burr-hole drainage depending on the type and location.
• Chronic subdural hematomas, common in older adults, frequently respond well to a small burr-hole procedure.

When to See a Neurosurgeon

You should be evaluated urgently if you have:

• A head injury followed by worsening headache, drowsiness, or vomiting
• Sudden neurological symptoms without a clear cause
• A known aneurysm, AVM, or prior brain bleed
• A new imaging finding of bleeding or a clot on the brain

At Nova Brain and Spine of Georgia, our board-certified neurosurgeons — including skull-base and cerebrovascular specialist Dr. Marcus Stephens — manage hemorrhages, hematomas, aneurysms, and traumatic brain injuries across Hampton, Atlanta, and Middle Georgia.

For an urgent neurosurgical evaluation, call (770) 297-8133.