The best predictor of outcome is the size of the hematoma. Massive cerebral hemorrhage is rapidly fatal and no treatment is indicated. Small hematomas recover like minor ischemic strokes, and management rests on control of risk factors, particularly hypertension, to prevent recurrence and avoidance of aspirin. It is the medium-size hematomas that demand urgent and vigorous treatment since these are life threatening through the development of mass effect. Neurosurgical advice should always be sought in these cases. The surgical management is discussed in detail elsewhere. Elderly patients and those with multiple bleeds (e.g. with amyloid angiopathy) fare badly. Functional recovery can be surprisingly good in younger subjects, and recurrence is rare and usually due to poor control of hypertension.

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