Intraventricular hemorrhage (IVH) occurs as a primary diagnosis and most commonly secondary to subarachnoid hemorrhage (SAH) and intracerebral hemorrhage (ICH). This chapter discusses the epidemiology, clinical presentation, neuro-imaging, grading scales, and prognostication for primary and secondary IVH. The most common associated risk factors for primary IVH are hypertension and vascular malformations. The clinical presentation of IVH secondary to ICH is more likely to include focal cerebral or cerebellar signs, and unlike ischemic stroke, often crosses cerebral arterial boundaries. The frequency of IVH in patients with ICH is related to the location and size of the parenchymal clot. Several scales and scoring systems have been developed to estimate the amount of IVH for the purpose of prognostication and for clinical decision-making for external ventricular drainage (EVD). The prognosis of primary IVH depends on the amount of ventricular blood, degree of hypertension, admission neurological status, and progression of symptoms.