Since the management of hemorrhagic stroke differs from that of ischemic stroke, prompt, accurate, and early diagnosis is vital in the management of patients who present with acute onset of focal neurologic symptoms and/or with altered mental status. Diagnostic imaging in the form of computed tomography scan or magnetic resonance imaging and a vessel study is required to ascertain the bleeding characteristic, location, and etiology. A multidisciplinary approach is required in the management of hemorrhagic stroke. Early diagnosis and treatment of the hemorrhagic stroke impacts the long-term outcome of such patients. This chapter reviews the common clinical presentations, diagnostic imaging modalities and prehospital and emergency department medical management of the most common types of hemorrhagic stroke.