Intraventricular hemorrhage(IVH)in patients with intracerebral hemorrhage is an independent risk factor. IVH can cause acute hydrocephalus by impairing cerebrospinal fluid dynamics. However, the pathological mechanism remains clear. In addition to the conventional concept of ventricular system obstruction by hematoma clots, secondary effects of heme and iron originating from hemoglobin might contribute to ventricular enlargement. The toxicity of accumulated hematoma in the ventricles might also influence the hydrocephalus and cause poor outcomes. An external ventricular drainage should be inserted promptly to control the intracranial pressure. Moreover, the hematoma should be removed as soon as possible to minimize the toxicity of the hematoma. The use of thrombolytic agents significantly reduces both the duration of ventricular drainage and mortality compared to external ventricular drainage alone. However, the functional outcome is not improved in patients with IVH. As another surgical option, endoscopy may be useful to evacuate the hematoma immediately. Finally, more evidence is essential for establishing the effectiveness of endoscopic techniques.