The origin and pathological type of brain metastases are mainly lung cancer. Hepatocellular carcinoma. Those with unknown primary foci are in the minority. Brain metastases are one of the common intracranial tumors, accounting for about 10-15% of cases [1], and are more common in men. As the population ages, the incidence of cancer increases incrementally. About 20-40% of patients with intermediate to advanced solid tumors develop brain metastases. Brain metastases starting with acute hemorrhagic stroke are rare. The incidence of brain metastases is likely to continue to increase as patients with tumors survive longer. The common primary sites of brain metastases are mainly lung cancer, followed by breast cancer, stomach cancer, colon cancer, kidney cancer, thyroid cancer, choriocarcinoma, and melanoma. Lymphoma and leukemia can also involve the brain, and a few brain metastases cannot be found as the primary lesion. Because of the rapid growth and strong toxicity of metastases, peri-tumor edema, brain tissue softening and necrosis, most brain metastases have increased intracranial pressure as the first symptom, and headache and vomiting appear early, and most patients also have neurological localization signs such as hemiparesis, aphasia and hemianesthesia. Some patients come to the clinic only with seizure symptoms when the cerebral cortex is involved. Some patients present with stroke as the first symptom. All cases in this group presented with acute hemorrhagic stroke symptoms and had only mid-stroke clinical presentation. CT and MRI are currently the most commonly used imaging modalities for brain metastases. It can be manifested as multiple nodules, single nodules or hemorrhagic metastases Many tumors such as lung cancer, choriocarcinoma and thyroid cancer can be accompanied by hemorrhagic changes. CT of hemorrhagic metastases shows high-density shadow within the lesion or uniform high-density shadow throughout the lesion, while MRI shows complex manifestations, which are related to the time of hemorrhage. Brain metastases progress rapidly and the median survival is only 1 month if left untreated [4]. Therefore, for patients with brain metastases, active and appropriate comprehensive treatment measures aim not only to stop or delay the occurrence of severe neurological symptoms and improve the patient’s survival quality; at the same time, the control of brain lesions can also buy time for treating the primary lesions, which is helpful to delay the survival time of patients. For patients with appropriate age, good general condition, no serious neurological symptoms, and basic stability or control of the primary lesion, metastasectomy is the treatment of choice, especially for patients with single-focus metastases. The patients in this group all had acute hemorrhagic stroke onset, plus the age of onset was more than middle-aged, and they were mostly considered to be hypertensive cerebral hemorrhage or hemorrhagic infarction before surgery. 2.Radiotherapy treatment includes whole brain radiotherapy, stereotactic radiotherapy and postoperative radiotherapy. Both whole brain and stereotactic radiotherapy have their own indications and advantages. For the two methods of treatment, the current consensus is that in order to avoid adverse consequences caused by whole-brain radiotherapy, whole-brain radiotherapy is not advocated for single lesions, but it is appropriate to cooperate with whole-brain irradiation for multifocal brain metastases. For radiotherapy after surgery, most scholars believe that for patients with better prognosis, complete resection after surgery plus radiotherapy is the best treatment. Chemotherapy is also one of the important means to treat tumor, often used as salvage treatment and or adjuvant treatment in case of recurrence after radiotherapy. With the progress and development of medical technology, the survival period of tumor patients has been prolonged and the incidence of brain metastases has been increasing; brain metastases have various ways of initiation, for brain metastases with acute hemorrhagic stroke, tumor resection should be actively performed while removing the hematoma. The possibility of stroke in brain metastases should also be considered before surgery. Early diagnosis and active treatment attitude, the appropriate use of surgery, radiotherapy and chemotherapy and comprehensive treatment means are important to prolong the survival time and improve the quality of life of patients with brain metastases.