Objective To explore the predictive value of BRAIN score combined with the ratio of peripheral blood monocytes to high-density lipoprotein （MHR） in early hematoma enlargement （EHE） of spontaneous intracerebral hemorrhage （ICH）. Methods The clinical data of 204 patients who completed the first head CT and blood collection within 6 hours of onset from January 2012 to September 2020 in our hospital were collected. The patients were divided into EHE and non-early hematoma enlargement （NEHE） group according to the result of re-examination of CT with 24 hours after onset. The data were analyzed by single factor analysis. Multivariate Logistic regression analysis was used to explore the independent related factors. The receiver operating characteristic （ROC） curve was used to analyze the predictive value of BRAIN score combined with MHR， that was， the new BMH score in EHE. Results There were 91 EHE cases （44.61%） and 113 NEHE cases （55.39%） among the 204 patients with ICH. Multivariate logistic regression analysis showed MHR （OR=3.31， 95%CI=1.17-9.38）， BRAIN score （OR=1.15， 95%CI=1.03-1.28） and GCS score （OR=0.67， 95%CI=0.55-0.82） were independent related factors （P＜ 0.05）. ROC curve analysis showed that the maximum