Optimal hemodynamic management in the neuro-intensive care unit is vital to prevent secondary brain injury in patients with acute brain insults such as ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, traumatic brain injury, and spinal cord injury. This chapter highlights key controversies in fluid therapy, blood pressure targets, cerebral perfusion pressure optimization, and the use of vasopressors and advanced hemodynamic monitoring. Individualized strategies, guided by multimodal monitoring—including intracranial pressure, cerebral autoregulation (PRx), cerebral oxygenation, and spinal cord perfusion pressure—are emphasized over generalized protocols. The utility of goal-directed therapy (GDT), transfusion thresholds, and coagulopathy management in neurocritical care is also discussed. While technological advances support personalized care, many recommendations remain based on moderate-quality evidence, underscoring the need for further high-quality research.