Spontaneous intracranial hemorrhage is a common neurological emergency associated with high morbidity and a case fatality rate between 25% and 48%. In the United States, there has been a rise in the number of cases of intracerebral hemorrhage. In general, incidence increases with age and is influenced by various factors such as hypertension, smoking, and anticoagulant use. Hypertensive vasculopathy and cerebral amyloid angiopathy are by far the most common etiologies in the older population. Vascular lesions, such as ruptured aneurysms and arteriovenous fistulas or malformations, are important causes in younger individuals and can also occur in older adults. In children, arteriovenous malformations are the most common cause of spontaneous intracerebral hemorrhage. In this chapter, we examine the major conditions that result in nontraumatic intracranial hemorrhage and review the role of imaging in diagnosis and prognostic implications.