Intracerebral hemorrhage (ICH) occurs as a result of bleeding into the brain parenchyma and formation of a focal hematoma. Treatment for ICH is primarily supportive, and outcome remains poor. Initial management is directed toward stabilizing breathing and circulation. Increased intracranial pressure is currently managed with osmotic agents (mannitol and glycerol); steroids, hypovolemia, controlled hyperventilation, and barbiturate coma can also be employed. Arterial blood pressure control is useful and requires adequate compliance to specific guidelines. Ultra-early hemostatic therapy may represent a promising tool to reduce early hematoma enlargement and to improve outcome.