A baseline severity score should be performed as part of the initial evaluation of patients with ICH (Class I; Level of Evidence B). (New recommendation) Rapid neuroimaging with CT or MRI is recom- mended to distinguish ischemic stroke from ICH (Class I; Level of Evidence A). (Unchanged from the previous guideline) CTA and contrast-enhanced CT may be consid- ered to help identify patients at risk for hematoma expansion (Class IIb; Level of Evidence B), and CTA, CT venography, contrast-enhanced CT, contrast- enhanced MRI, magnetic resonance angiography and magnetic resonance venography, and catheter angiography can be useful to evaluate for underlying structural lesions including vascular malformations and tumors when there is clinical or radiological sus- picion (Class IIa; Level of Evidence B). (Unchanged from the previous guideline) Medical Treatment for ICH Hemostasis and Coagulopathy, Antiplatelets, and Deep Vein Thrombosis Prophylaxis Underlying hemostatic abnormalities can contribute to ICH. Patients at risk include those taking oral anticoagulant drugs (OACs), antiplatelet agents, those with acquired or congeni- tal coagulation factor deficiencies, and those with inherited or acquired qualitative or quantitative platelet abnormali- ties. Patients taking OACs constitute 12% to 20% of patients a rate that has increased with the aging popu- lation and increased use of anticoagulant drugs in recent Vitamin K antagonists (VKAs) such as warfarin are the most frequently prescribed OAC, but new agents that do not require laboratory monitoring and do not necessarily prolong coagulation screening tests are being increasingly used, including dabigatran,71 These new agents appear to be associated with a lower risk of ICH than VKAs.74 It is important that providers caring for ICH patients recognize the use of antithrombotic drugs or of an underlying coagulopathy in the initial evaluation of patients with ICH, so that the treatment strategy can include appropriate interventions. 