Intracerebral hemorrhage (ICH) accounts for between 10% to 30% of first-ever strokes; outcomes are significantly worse than with ischemic stroke with a 30-day mortality rate up to 50%, furthermore, half of the deaths occur in the acute phase. Intracerebral hemorrhage (ICH) is classified as primary or secondary according to the underlying etiology. Primary ICH (about 80%) comes from the spontaneous rupture of small vessels more often in relation to long-standing or uncontrolled arterial hypertension and is generally located in the basal ganglia and internal capsula. Secondary ICH (about 20%) is often associated with vascular abnormalities, tumors, and anticoagulant therapy or coagulation disorders, more frequently located in cerebral lobes or subtentorial (cerebellum or pons). Rapid recognition and diagnosis of ICH as well as identification of early prognostic indicators are essential for planning the level of care and avoiding acute rapid progression during the first hours. Hematoma size has been identified as one of the most important predictors of 30-day mortality and its expansion is highly predictive of neurological deterioration. Blood pressure management remains, although controversial, the first-line medical approach along with possible new and effective treatments coming from the numerous between pilot and larger randomized medical trials for ICH completed in the past decade.