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Patients with severe intracerebral hemorrhage (ICH) often experience delayed neurologic worsening because of mass effect leading to brain compression.1 However, mass effect in patients with unilateral hemispheric brain lesions, such as a large intraparenchymal hematoma, causes a pressure gradient that can result in subfalcine and transtentorial herniation without global intracranial hypertension.2,3 Consequently, intracranial pressure (ICP) monitoring is a less established practice for patients with ICH than it is for patients with diffuse brain injury, such as those with severe trauma or poor-grade subarachnoid hemorrhage.
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