Cerebral hemorrhage mostly occurs in patients over 50 years of age with hypertension, and is especially common between 60 and 70 years of age. However, in recent years, there is an increasing trend of patients under 50 years old, and there is not much difference between genders. It occurs in patients with obesity, flushed face, short neck and wide shoulders, and some cases may have family history. The onset of bleeding is often sudden, and most patients have no prodromal symptoms before bleeding. The severity of clinical manifestations after bleeding is greatly dependent on the site of bleeding, the amount of bleeding, the speed of bleeding, and the compensatory capacity. The enlargement of the hematoma due to persistent bleeding is one of the causes of exacerbation. The enlargement of the hematoma tends to occur in patients with basal ganglia and thalamus, and the morphology of the hematoma is more irregular than round or regular. It is generally considered to be an enlarged hematoma if the hematoma volume increases by more than 50% of the volume of the first CT hematoma, or if there is a difference of more than 20 ml between the two hematoma volumes. The manifestation is sudden or gradual deepening of the patient’s consciousness and continuous increase in blood pressure. 1.Prodromal phase Generally, there is no premonition before the disease. A few patients may have headache, dizziness, transient confusion, drowsiness, psychiatric symptoms, transient limb movement inconvenience, abnormal sensation or slurred speech and other brain symptoms a few hours or days before the hemorrhage, and other symptoms such as retinal hemorrhage or nasal hemorrhage may also appear. These symptoms are mainly related to hypertension and are not the unique prodromal symptoms of cerebral hemorrhage. 2. Onset Most patients have a rapid onset, often developing to a peak within minutes or hours, and may fall into coma within minutes, while only a small number of patients develop more slowly, developing to a peak only after several days, similar to ischemic cerebral infarction. (1) Headache: It is often the first symptom, manifested as a sudden and severe headache, first located in the temporal region of the affected side, and then throughout the head or the posterior occipital region, caused by blood stimulation of pain-sensitive structures in the skull and increased intracranial pressure. Note that aphasic patients can only indicate headache by stroking their head with their hands; a small number of supratentorial cerebral hemorrhage and some elderly patients have only mild headache or no headache. (2) Dizziness: It can be accompanied by headache or be the main manifestation, mostly occurring in posterior cranial sulcus subscriptive hemorrhage. (3) Nausea and vomiting: It is one of the early symptoms and is more obvious when the headache is severe, but in the case of subcranial hematoma, the headache is not severe and vomiting can still be very frequent; if vomiting coffee-colored material, it indicates damage to the subthalamic area. Vomiting is mostly due to increased intracranial pressure or brainstem damage. (4) Disorders of consciousness: cloudy consciousness and drowsiness in mild cases, coma, denervation and hyperthermia in severe cases; a very small amount of hemorrhage can be without obvious disorders of consciousness. There are also cases of impaired consciousness a few days after bleeding, which may be related to cerebral edema and rebleeding. (5) Increased blood pressure: In most cases, the blood pressure is between 170-250/100-150 mmHg, which is due to pre-existing hypertension or compensatory increase in blood pressure due to increased intracranial pressure and brainstem ischemia. (6) Pupillary changes: Generally, when the amount of hemorrhage in the cerebral hemisphere is not large, the pupil size is normal and the light response is good, sometimes the pupil on the sick side is smaller than the opposite side. If brain herniation occurs and the arteriolar nerve is compressed, the ipsilateral pupil becomes dilated, the light response is blunted or disappears, the margins are not aligned, and if the condition continues to worsen, the contralateral pupil also becomes dilated. If the brainstem and bridge hemorrhage or ventricular hemorrhage enters the subarachnoid space, the pupil is often pinpoint narrowed. (7) Other: fundus examination reveals arteriosclerosis, retinal hemorrhage and optic papillary edema; meningeal irritation signs due to hemorrhage entering the subarachnoid space; hemorrhage occupancy and destruction of brain tissue leading to hemiplegia, aphasia and changes in eye position, etc. In conclusion, a typical intracerebral hemorrhage first presents with headache, nausea, vomiting, and after a few minutes to hours, signs of impaired consciousness and focal neurological deficits, slow and strong pulse, flushing, profuse sweating, incontinence, elevated blood pressure, and even convulsions, deepening coma, snoring breathing, or in severe cases, tidal breathing, and then irregular or intermittent breathing. If brain herniation occurs, the condition will deteriorate further and dangerous symptoms such as vomiting blood, rapid pulse, high body temperature, and falling blood pressure will appear.