Spontaneous intracerebral haemorrhage is defined as a collection of blood in the cerebral parenchyma that is not caused by trauma. It represents roughly 10–20% of all strokes.

The clinical presentation is unspecific and the diagnosis requires brain imaging. ICH is a medical emergency and ICH patients have to be admitted in an acute stroke unit.

The priority is to fight against ICH expansion. The first step consists in the administration of a specific antagonist of the antithrombotic treatment when available, and in the strict control of blood pressure. Clinicians should keep in mind that the concept of so-called “primary” ICH is misleading since many causes should be searched for.

During follow-up, the risk of recurrence may depend on the underlying vessel disease and blood pressure should be strictly managed. ICH patients are at high risk of dementia: cognitive evaluation should regularly be performed during follow-up.