Objective To investigate the risk factors for the onset and death of intracranial hemorrhage （ICH） in patients with brain metastases （BM） undergoing stereotactic radiosurgery （SRS）.Methods A total of 392 patients with BM who met the inclusion and exclusion criteria were selected， and their clinical data were analyzed， including patient items， SRS items， blood items， and imaging items. According to the presence or absence of bleeding after SRS， the patients were divided into ICH group with 134 patients and non-ICH group with 258 patients. A logistic regression analysis was performed for both groups to investigate the risk factors for the onset of ICH in the two groups， and it was performed for the ICH group to investigate the risk factors for death due to ICH.Results ICH history and the primary lesion of malignant melanoma were risk factors for the onset of ICH in BM patients after SRS， and the risk of ICH was increased by 7.433 times in patients with ICH history and 1.430 times in patients with malignant melanoma as the primary lesion （all P <0.05）. The ICH group had a 7-day mortality rate of 11.19% and a 30-day mortality rate of 25.37%. Hypertension， low platelet count， cerebral hernia， and hydrocephalus were risk factors for death within 7 days， and the risk of death due to ICH was increased by 2.998， 3.784， 2.289， and 3.443 times， respectively， in patients with hypertension， low platelet count （for every 10⁹/L reduction）， cerebral hernia or hydrocephalus （all P <0.05）. Cerebral hernia and hydrocephalus were risk factors for death within 30 days， and the risk of death due to ICH was increased by 3.250 and 4.453 times， respectively， in patients with cerebral hernia or hydrocephalus （all P <0.05）.Conclusions It is necessary to prepare for prevention and treatment in advance for patients with corresponding risk factors， so as to reduce the incidence and mortality rates of ICH. ［Journal of International Neurology and Neurosurgery, 2023, 50(6): 34-39］