Intracranial hemorrhage refers to bleeding within the cranial vault and encompasses a spectrum of conditions including intracerebral hemorrhage, subdural hematoma, epidural hematoma, and subarachnoid hemorrhage. These entities may arise from traumatic injury, vascular pathology, hypertension, anticoagulation, or spontaneous vessel rupture. Intracranial hemorrhage constitutes a neurosurgical emergency due to the risk of rapid neurological deterioration from mass effect, increased intracranial pressure, and secondary brain injury.

Clinical presentation varies according to hemorrhage type, size, and location. Patients may present with acute headache, vomiting, altered consciousness, focal neurological deficits, seizures, or rapid neurological decline. Epidural and subdural hematomas often follow head trauma, whereas intracerebral hemorrhage may present spontaneously with sudden neurological deficit. Subarachnoid hemorrhage typically presents with abrupt, severe headache and meningeal signs.

Neurosurgical evaluation begins with urgent neurological assessment and immediate neuroimaging. Non-contrast computed tomography is the primary diagnostic modality, enabling rapid identification of hemorrhage type, volume, mass effect, and midline shift. Serial imaging may be required to assess hematoma expansion or evolving cerebral edema.

Surgical intervention is indicated in selected cases based on hematoma size, neurological status, rate of deterioration, and imaging findings. Surgical goals include evacuation of the hematoma, reduction of intracranial pressure, and prevention of secondary injury. The decision to operate is individualized and balances surgical risk against the potential for neurological recovery.

Postoperative management is critical and involves close neurological monitoring, intracranial pressure control, and management of systemic factors such as blood pressure and coagulation status. Prevention of complications including infection, seizures, and hydrocephalus is integral to care.

Long-term outcomes depend on hemorrhage etiology, timeliness of intervention, and extent of initial brain injury. Survivors may require prolonged neurological follow-up and rehabilitation.

Intracranial hemorrhage requires rapid diagnosis, decisive neurosurgical judgment, and coordinated postoperative care to optimize survival and neurological outcomes.