Transforming Intracerebral Hemorrhage Care with Artificial Intelligence: Opportunities, Challenges, and Future Directions

Spontaneous intracerebral hemorrhage (ICH) is associated with substantial mortality and morbidity. Current management paradigms rely heavily on the rapid interpretation of neuroimaging and clinical data, yet are frequently constrained by limitations in processing speed, diagnostic accuracy, and prognostic precision. Artificial intelligence (AI), specifically machine learning (ML) and deep learning (DL), offers transformative potential to circumvent these challenges across the entire continuum of ICH care. This comprehensive review synthesizes the rapidly evolving landscape of AI applications in ICH management. Through a systematic evaluation of recent literature, we examine studies focused on the development, validation, or critical appraisal of AI-driven technologies for ICH care. Our analysis encompasses automated neuroimaging, computer-assisted surgical navigation, brain-computer interfaces (BCIs), prognostic modeling, and fundamental research into disease mechanisms. AI has demonstrated performance comparable to that of clinical experts in automating hematoma segmentation, predicting complications such as hematoma expansion, and refining surgical planning via augmented reality. Furthermore, BCIs present innovative therapeutic avenues for motor rehabilitation. However, the translation of these technological advances into routine clinical practice is impeded by substantial challenges, including data heterogeneity, model opacity ("black-box" issues), workflow integration barriers, regulatory ambiguities, and ethical concerns surrounding accountability and algorithmic bias. The integration of AI into ICH care signifies a paradigm shift from standardized treatment protocols toward dynamic, precision medicine. Realizing this vision necessitates interdisciplinary collaboration to engineer robust, generalizable, and interpretable AI systems. Key priorities include the establishment of large-scale multimodal data repositories, the advancement of explainable AI (XAI) frameworks, the execution of rigorous prospective clinical trials to validate efficacy, and the implementation of adaptive regulatory and ethical guidelines. By systematically addressing these barriers, AI can evolve from a mere analytical tool into an indispensable clinical partner, ultimately optimizing patient outcomes.