Intracerebral hemorrhage (ICH) refers to bleeding into brain parenchyma, with or without extension into the ventricles or convexity subarachnoid space. ICH that occurs in the absence of trauma, subacute infarction, tumor, or cerebrovascular malformations is called primary or spontaneous ICH. The management and prognosis of hemorrhagic brain tumors, large infarctions, severe traumatic brain injury, and ruptured vascular malformations are unique and determined by the structural injuries and pathologies underlying those conditions. For the remainder of this chapter, our use of the term ICH will refer to primary ICH unless otherwise stated. The mechanisms of injury in ICH may be considered in two categories: structural and biochemical. The extravasation of blood into the surrounding parenchyma leads to physical disruption and mechanical damage of the glial cells and neurons and, in severe cases, brain compression leading to herniation syndromes.[1]