This article represents the recommendations for the management of spontaneous intracerebral haemorrhage of the European Stroke Initiative (EUSI). These recommendations are endorsed by the 3 European societies which are represented in the EUSI: the European Stroke Council, the European Neurological Society and the European Federation of Neurological Societies.

While there have been substantial improvements in the management of patients with cerebral infarction and there are likely to be further improvements over the next decade, the same may not be true for cerebral haemorrhage. Diagnostic facilities and neurosurgical techniques have improved but not all patients are benefiting from these. The current literature is reviewed. Further controlled trials of the utility of modern neurosurgical techniques are urgently required as at present no therapeutic intervention holds out hope for these patients other than optimum medical management. The main focus must be on prevention.