OBJECTIVE: This study explores the correlation between admission hemoglobin (HGB) concentration and the Black Hole Sign (BHS) presence on cranial CT scans in spontaneous intracerebral hemorrhage (ICH) patients. Given the prognostic value of BHS in predicting early hematoma expansion and the potential role of HGB levels in influencing outcomes in cerebrovascular conditions, this study seeks to explore the correlation between these two factors. By analyzing clinical and imaging data from the past five years, we aim to provide new insights into the relationship between HGB concentrations and BHS in ICH patients. METHODS: A single-center cross-sectional study gathered data from 330 ICH patients admitted to Chongqing Emergency Medical Center's neurosurgery department between June 2018 and November 2023. Logistic regression and subgroup analysis analyzed the association between admission HGB concentration and BHS occurrence. Curve fitting evaluated any linear relationship. RESULTS: Among 330 patients (mean age: 58.4 ± 13.1 years, 72.1 % males), 40.0 % exhibited BHS on initial CT scans. Multifactorial adjustments revealed a negative correlation between admission HGB concentration and BHS. In subgroup analyses of age, sex, volume of cerebral hemorrhage, insular leaf damage, cerebral hernia, thalamic hemorrhage, and ventricular hemorrhage, No significant interactions were observed between subgroups. For every 1 g/L rise in HGB upon admission, there was a 3 % reduction in BHS likelihood (OR: 0.97, 95 % CI: 0.95-0.99). CONCLUSIONS: Lower admission HGB concentrations in spontaneous cerebral hemorrhage patients correlated with increased BHS incidence on cranial CT scans. These findings underscore the importance of balanced HGB levels in ICH patients, potentially serving as a protective measure against stroke risk. Given the possible negative impact of low hemoglobin levels on coagulation and outcomes after a hemorrhage, we advise that middle-aged and elderly individuals with hypertension and other stroke risk factors receive regular medical evaluations. However, given the cross-sectional design of this study, the causal relationship between HGB levels and the BHS should be further validated through prospective cohort studies and large-scale, multicenter trials.