There are many intracranial lesions causing spontaneous intracerebral hemorrhage, including hypertension, aneurysm, arteriovenous malformation, bleeding tumor, coagulopathy, amyloid angiopathy. In fact, the management of spontaneous intracerebral hemorrhage remains still a complex problem. The patient's age and consciousness, general condition, the hematoma location, as well as the cause combine to affect the management outcome. In general, mortality and morbidity is increasing with greater patient's age and hematoma size, deeper hematoma location. The emergent care and management usually are needed in almost all the patients with medical and surgical treatments. Acute medical management is required to control increased intracranial pressure, to stablize cardiorespiratory system, and prevent further compication such as brain edema, hematoma expansion, seizure. Emergent surgical treatment should be considered when surgical removal of hematoma would be benefit the patient's condition by decreasing mass effect and protecting the secondary injury to the surrounding normal brain.