Thanks largely to acute lowering of BP can now be considered safe and potentially effective for improving outcome in most instances of ICH. Ongoing and future studies in this area, such as ATACH II,324 will seek to solidify the evidence for efficacy of BP lowering and refine the BP ranges and targets that should be applied in practice. These studies will also address other outstanding questions, such as whether the spot sign or other neuroimaging findings identify patients more likely to benefit from BP lowering.325 Although current evidence does not establish a general strategy of early surgery for supratentorial ICH, studies will continue to seek subgroups of patients who benefit. Another major focus in future years will be determining whether minimally invasive surgery231 can provide the advantages of hematoma removal with less surgical trauma and there- fore greater net benefit to patients. Another rational but still unproven approach to acute ICH treatment is neuroprotec- tion of surrounding brain tissue from the toxic effects of the hematoma. The translation of biological data on neuro- protection from animals to human ICH patients may face the same difficulties encountered by the ischemic stroke neuroprotection field, such as identifying the correct animal model system and a clinically relevant time frame for treat- Emerging methods such as prehospital administra- tion of candidate neuroprotectants327 should increase the range of feasible treatment approaches and time windows for acute ICH. 