Neurocritical care is a specialty that focuses on the critical care management of patients with catastrophic neurologic diseases such as traumatic brain injury, subarachnoid hemorrhage and intracerebral hemorrhage. Traditionally, neuromonitoring is based on a “reactive” model, in which abnormal physiology or neurological deterioration is detectedm, which then triggers corrective actions to reverse this process. Multimodality monitoring refers to the tracking of multiple parameters of brain physiology and function that can be affected by direct medical or surgical intervention. We propose a novel paradigm to assess the pathophysiological events that accompany acute hemorrhagic stroke by combining the use of emerging neuromonitoring modalities in a Neuro-ICU. This overall vision of this project is to establish a new therapeutic paradigm in which multimodality neuromonitoring is used to provide real-time feedback, allowing the clinician to optimize systemic physiology, thus creating an optimal cellular environment that will both preserve neurologic function and allow the best chance for recovery to occur. The specific goals of this project are: 1) To create software tools for the bedside that enable physicians to evaluate relationships between systemic physiological variables and indicators of neuronal health in real time. 2) Determine if two brain tissue measures of neuronal oxidative stress - oxygen tension and lactate/pyruvate ratio - can be optimized by the manipulation of systemic physiological variables such as blood pressure, osmolality, and temperature in patients with hemorrhagic stroke. 3) Determine whether the extent and duration of neuronal oxidative stress and physiological derangement is predictive of long term clinical and functional outcome after hemorrhagic stroke.