Spontaneous intracranial haemorrhage may present as a surgical emergency requiring rapid assessment of the patient and rapid access to diagnostic imaging. The site of the haemorrhage will determine whether there is global cerebral dysfunction or the development of a focal deficit. Hydrocephalus may complicate intracranial haemorrhage. Immediate decision making as to the timing and means of treatment of the patient and the appropriateness of any intervention may be necessary. In this chapter we discuss the common types of intracranial haemorrhage, the significant features of the assessment and how these are used to guide treatment. Recent multicentre clinical studies have influenced decision making for this group of patients.