Full PubMed searches were conducted of all English language articles regarding relevant human disease treatment from 2009 through August 2013. Drafts of summaries and rec- ommendations were circulated to the entire writing group for feedback. Several conference calls were held to discuss indi- vidual sections, focusing on controversial issues. Sections were revised and merged by the Chair. The resulting draft was sent to the entire writing group for comment. Comments were incorpo- rated by the Chair andVice-Chair, and the entire committee was asked to approve the final draft. Changes to the document were made by the Chair and Vice-Chair in response to peer review, and the document was again sent to the entire writing group for suggested changes and approval. Recommendations follow the American Heart Association/American Stroke Association's methods of classifying the level of certainty of the treatment effect and the class of evidence (Tables 1 and 2). All Class I recommendations are listed in Table 3. Emergency Diagnosis and Assessment ICH is a medical emergency. Rapid diagnosis and attentive management of patients with ICH is crucial, because early deterioration is common in the first few hours after ICH onset. More than 20% of patients will experience a decrease in the Glasgow Coma Scale (GCS) of 2 or more points between the prehospital emergency medical services (EMS) assessment and the initial evaluation in the emergency department (ED).6 Furthermore, another 15% to 23% of patients demonstrate continued deterioration within the first hours after hospital The risk for early neurological deterioration and the high rate of poor long-term outcomes underscore the need for aggressive early management. 