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This chapter explores the management issues surrounding a hemorrhagic stroke of the cerebellum, one of the most common sites for intracerebral hemorrhage, and one where proper management can have a profound impact on outcome. It presents a case study of a 75-year-old female with a history of hypertension and end-stage renal disease requiring dialysis. Examination consistently revealed appropriate, symmetric limb movements and limited cranial nerve exams. Computed tomography scans showed satisfactory decompression of the posterior fossa and absence of hydrocephalus. Intracerebral hemorrhage is most commonly associated with chronic hypertension, amyloid angiopathy, anticoagulation, trauma or underlying pathology such as tumor or vascular malformation. As ventricular obstruction may occur when the patient is positioned, prepared or opened, allowing access for an emergency external ventricular drainage device is desirable in preparing and draping the patient.