Introduction: Intraparenchymal hematomas (IPH) are defined as spontaneous blood extravasation within the brain parenchyma, without any traumatic context. IPH represents a medical and surgical emergency that can be life-threatening if not managed appropriately. Objectives and Methods: The aim of our study was to describe the epidemiological, clinical, paraclinical, therapeutic, evolutionary, and prognostic aspects of IPH in medical neurocritical care. To this end, we conducted a retrospective analysis of the medical records of patients admitted to the medical neurocritical care unit from January 1, 2022, to December 31, 2023. Results: The study included 72 patients. The mean age was 56.25 years, with a male-to-female ratio of 2:1. Arterial hypertension was the main risk factor (73.6%). Disorders of consciousness (69.4%) were the leading reason for admission. Neurological signs were dominated by signs of intracranial hypertension syndrome (62.5%), impaired alertness (70%), hemiplegia (68%), and speech disturbances (41.7%). The mean Glasgow Coma Scale score was 8, and the average NIHSS score was 17. Supratentorial hematomas were the most frequent on brain CT scans (91%) — capsulo-lenticular (41%), thalamo-capsulo-lenticular (35%), and lobar (16%). The mean ICH score was 3. Management included strict control of blood pressure and prevention of secondary cerebral insults. Neurosurgical intervention was performed in 9% of patients. Complications were mainly infections and brain herniation. The mortality rate from IPH was 33.3%. Conclusion: IPH constitutes a medical and surgical emergency. Management must be prompt and adapted in hospital settings equipped with stroke units, neurocritical care, and neurosurgical facilities in order to reduce morbidity and mortality.