To investigate the relationship between neutrophil/lymphocyte ratio (NLR) and early hematoma enlargement (HE) in spontaneous intracerebral hemorrhage (ICH). Methods: The clinical data of 198 patients with ICH within 6 hours of onset was collected. All the cases had the first CT scan and blood collection in 6 hours of onset and had the second CT scan 6～24 h of onset. According to the data of CT scan, cases were divided into the early hematoma enlargement (HE) group and the hematoma unexpanded (non-HE) group. The clinical data of NLR within 6 hours (T0), 6-24 hours (T1) and other possible influence factors were compared between the two groups. Results: In 198 ICH cases, 87 had early hematoma enlargement and 111 had no early hematoma enlargement. Univariate analysis showed statistically significant differences in gender, drinking history, systolic blood pressure and diastolic blood pressure at admission, Glasgow Coma Scale (GCS) score, hematoma volume, the speed of ultraearly hematoma growth(uHG), NLRT1, blood glucose at admission, surgical treatment rate, pulmonary infection rate and in-hospital mortality rate between two groups (all P<0.05). Logistic regression analysis showed that NLRT1, GCS score, and uHG were independent correlated factors of HE. ROC curve analysis showed that when the NLRT1 cutoff value was 7.65, the sensitivity of predicting HE in ICH patients was 78.16%, the specificity was 81.98%, and the area under the ROC curve was 0.852 (95%CI: 0.798-0.907, P=0.00). Conclusion: The NLR of ICH patients with HE is significantly elevated, and NLR within 6-24 hours of onset may be a predictor of HE.