Perihematomal brain edema (PHBE) plays an important role in secondary brain injury after intracerebral bleeding. Perihematomal brain edema is commonly observed during the acute and subacute phases in patients with intracerebral hemorrhage (ICH). In human studies, early CT scans demonstrate that PHBE develops within three hours of symptom onset. Magnetic resonance imaging is playing an evermore important role in the evaluation of hyperacute cerebrovascular disease. Several mechanisms are implicated in the development of neurological deterioration in patients with ICH. Single-photon emission computerized tomography (SPECT) is useful in the study of PHBE evolution. Several drugs have demonstrated their benefit in PHBE treatment in animal models, and in the future may block PHBE development in clinical practice. Deferoxamine and other iron chelators attenuate brain edema in ICH, and may be potential therapeutic agents for treating ICH, reducing the oxidative stress caused by the release of iron from the hematoma.