Key messages

• Surgical evacuation of an intracerebral hematoma may be lifesaving.

• Further surgical intervention is usually aimed at the prevention of rebleeding.

• Medical measures to reduce intracranial pressure can reduce secondary brain damage while surgical intervention is awaited.

• The surgical management of hypertensive intracerebral hemorrhage remains very controversial and clinical trials to evaluate the role of surgery are in progress.

• Do not treat reactive hypertension as low systemic blood pressure may reduce cerebral perfusion pressure.

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