Intracerebral hemorrhage is the stroke subtype with the highest mortality rate (40% to 50%). Until the hypotheses investigating the amelioration of disease severity factors are completely tested and found to be correct, intracerebral hemorrhage will remain the leading cause of stroke morbidity and mortality in the United States. The acute management of intracerebral hemorrhage with particular emphasis on the evolving areas of probable therapeutic benefit, which are early stabilization, management of mass effect by intraventricular clot removal, and intracranial pressure management, are reviewed.