<![CDATA[Hemorrhagic stroke caused by intracerebral hemorrhage is a neurological emergency with high morbidity and mortality that requires prompt and appropriate management. Hypertension is the most common risk factor, particularly for deep hemorrhage in the basal ganglia. This case report aims to describe the clinical features, diagnosis, and management of spontaneous intracerebral hemorrhage accompanied by signs of raised intracranial pressure. A 45-year-old man presented to the emergency department with a sudden decrease in consciousness, preceded by acute right-arm weakness and vomiting. Examination revealed a somnolent patient with a Glasgow Coma Scale of E2M3V2, blood pressure of 207/118 mmHg, and right hemiparesis. Non-contrast head computed tomography showed a left basal ganglia hemorrhage of approximately 39.7 cc with perifocal edema, midline shift, and left lateral ventricle compression. Raised intracranial pressure was identified through decreased consciousness, vomiting, and neuroimaging findings of mass effect. Management comprised airway protection, controlled blood-pressure reduction with intravenous nicardipine, hyperosmolar therapy with mannitol, and neurosurgical decompressive craniectomy with hematoma evacuation. The patient's consciousness improved from a Glasgow Coma Scale of 7 to 15, although motor aphasia and right hemiparesis persisted. This case demonstrates that spontaneous intracerebral hemorrhage with raised intracranial pressure demands rapid diagnosis and comprehensive treatment, in which timely medical and surgical intervention may reduce mortality and improve prognosis.]]>
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