A ruptured brain arteriovenous malformation (AVM) is a brain AVM that has bled, usually as an intracerebral haemorrhage (ICH). Care follows the clinical course. The first step is to find the cause, because an AVM can lie behind what looks like a spontaneous ICH, and the work-up runs from non-invasive angiography to catheter angiography. The second is timing: what has to be treated during the acute phase, and what can wait until the patient has recovered from the haemorrhage. The nidus is then removed by microsurgery or obliterated by stereotactic radiosurgery (SRS), or treated within a combined plan that may include embolisation. Counselling covers functional recovery and the risk of seizures.