Life threatening intra cerebral haemorrhage (ICH) is the most serious complication of oral anti-coagulation therapy (OAT) with mortality in excess of 50%.early intervention focuses on rapid correction of coagulopathy in order to prevent continued bleeding.  Although management guidelines for such haemorrhages are available for the older generation anticoagulants, they are still lacking for newer agents, which are becoming popular among physicians. Supportive care, including blood pressure control, and reversal of anticoagulation remain the cornerstone of acute management of AICH. A case report of young lady of age 29yrs old came with chief compliant of headache, vomiting and involuntary maturation, sudden loss of vision both eyes .she  had history of CRHD(chronic rheumatic heart disease) with severe mitral valve stenosis and of post Operative MVR(mitral valve replacement).    Altered sensorium after surgery .past medication history was using Acenocoumarol (acenocoumaral) 3mg for 15 days .while observing the patient. Patient was irritable nd abdomen was soft, neck was stiff. Acenocoumarol has been induced intra cerebral haemorrhage in patient and also lead to sub dural haemorrhage infract temporal parietal region