Spontaneous intracerebral haemorrhage (ICH) is nontraumatic bleeding in the brain parenchyma, which can extend into the ventricles and the subarachnoid space. There are many dilemmas in the management of ICH, ranging from the management of elevated blood pressure to the surgical management of ICH. This chapter addresses all the controversial issues in light of recent evidence and provides conclusions for the readers on each subtopic. Blood pressure management forms the cornerstone of ICH treatment, and we have reached the target systolic blood pressure of 140 mm Hg based on current understanding of available evidence. Similarly, guidelines for the reversal of anticoagulants and antiplatelets are now clear and are outlined in the text, which is derived from the recent stroke guidelines published in 2022. We have received encouraging news about the surgical management of ICH. We now know that minimally invasive surgery plays a role in the early treatment of ICH. We have chosen not to focus on hyperosmolar therapy for managing ICH as there have been no recent developments in this area. With several new studies underway and the rapidly evolving landscape of ICH, this chapter will soon need to be re-evaluated.