1. An initial assessment and stabilization of airway patency, breathing, and circulation should be performed. Once clinical stability is achieved, urgent neuroimaging should be obtained for rapid and accurate diagnosis of intracranial hemorrhage (ICH).

2. Complete a standardized neurologic assessment to determine baseline severity. The National Institutes of Health Stroke Scale (NIHSS), if the patient is awake or drowsy, or the Glasgow Coma Scale (GCS), if the patient is obtunded or comatose, should be performed and clearly documented.

3. Blood pressure management, treatment of thrombocytopenia (platelet goal of 100,000/mm3), reversal of coagulopathy, and evaluation of the need for early surgical intervention are the mainstays of ICH treatment.

4. Frequent neurological examinations, at least every hour, to detect early clinical deterioration and signs of increased intracranial pressure (ICP) should be part of the initial management algorithm.

5. A complaint of pain in cancer patients with thrombocytopenia may indicate life threatening bleeding. A complaint of headache in a cancer patient with thrombocytopenia, even without abnormal neurologic findings, is ICH until proven otherwise.