Summary. Introduction. Intracerebral hemorrhage (CH) is the main hypertensive mechanism occurring as the consequence oj stuctural changes in the small perforating vessels of the cerebra! hemispheres and brain stem. Development. These vascular lesions cause deeply situated hemorhages in the cerebra! hemispheres (basal grey nuclei and thalamus) and brain stem (pons); less common sites are in the subcorticalwhite maer and cerebelhm. There are many non-hvpertensive causes of ICH incuding: amvloid cerebra angiopathy, vascular malformations intracranial tumours, the use ofanticoagulant and fibrinolytic agents, sympathomimetic drug! and vasculitis. These conditions usually cause hemorrhages situated in the subcotical white matter (obar, some predominantly in the elder'y (amyloid cerebral angiopathy) and others mainly in the young vascular malformations and consumption of svmpathomimetic drugsl.Radiological diagnosis of ICH is easily made on computerized tomography (C7). and magnetic resonance (MR) gives additional data such as the sfage ofevolution of the hemorrhage and its possible causes vascular maformations. under'iving tumours The therapeutic management ofICH inchdes: immediate emergency treatment (the need for endotracheal intubation, control of the blood pressure) and the management of the conditions causing ICH (coagulation disorders, detection of toxic substances such as cocaine and other sympathomimetic agents), treatment of intracranial hypertension (ypeventilation, osmotic diuretics, barbiturate coma): the decision to proceed to surgery (reserved for patients with cerebellar bleeding accompanied by supratentoria! hvarocephalus, lobarhemothage ofintermediate size togetherwith progressive neurological aeterioration and signs ofa space occupying lesioi on CT, and ventriculostomy for thalamic or caudate nucleus bleeding with hdrocephalus) /REV NEUROL 1999: 29: 1330-71