(Unchanged from the previous guideline) Management of Medical Complications A formal screening procedure for dysphagia should be performed in all patients before the initiation of oral intake to reduce the risk of pneumonia (Class I; Level of Evidence B). (New recommendation) Surgical Treatment of ICH Patients with cerebellar hemorrhage who are deteriorating neurologically or who have brainstem compression and/or hydrocephalus from ventricular obstruction should undergo surgical removal of the hemorrhage as soon as possible (Class I; Level of Evidence B). (Unchanged from the previous guideline) Prevention of Recurrent ICH BP should be controlled in all ICH patients (Class I; Level of Evidence A). (Revised from the previous guideline) Measures to control BP should begin immediately after ICH onset (Class I; Level of Evidence A). (New recommendation) Rehabilitation and Recovery Given the potentially serious nature and complex pattern of evolving disability and the increasing evidence for efficacy, it is recommended that all patients with ICH have access to multidisciplinary rehabilitation (Class I; Level of Evidence A). (Revised from the previous guideline) BP indicates blood pressure; CT, computed tomography; DVT, deep vein thrombosis; EEG, electroencephalography; ICH, intracerebral hemorrhage; INR, international normalized ratio; MRI, magnetic resonance imaging; SBP, systolic blood pressure; and VKA, vitamin K antagonist. Neuroimaging The abrupt onset of focal neurological symptoms is presumed to be vascular in origin until proven otherwise; however, it is impossible to know whether symptoms are caused by ischemia or hemorrhage on the basis of clinical characteristics alone. Vomiting, systolic BP (SBP) >220 mmHg, severe headache, coma or decreased level of consciousness, and symptom pro- gression over minutes or hours all suggest ICH, although none of these findings are specific; neuroimaging is thus mandatory.40 CT and magnetic resonance imaging (MRI) are both reasonable for initial evaluation. 