Abstract Introduction: Intracerebral hemorrhage (ICH) is characterized to be the most lethal form of stroke, with high rates of mortality, not only during the acute phase (39%), but also 3 months later (33.5%) with a significant long-term disability. The National Institutes of Health Stroke Scale (NIHSS) score is a purely clinical scale, is easily administrable, and does not require the use of any additional diagnostic procedure. Objectives: To evaluate if the admission NIHSS score in acute primary ICH patients can be a predictive tool for their short-term outcome. Patient and methods: We included 120 patients diagnosed with spontaneous ICH. All patients were subjected to full history taking, general, and neurological examination with assessment of neurological function on admission using the NIHSS. Laboratory assessment on admission including complete blood count, routine liver and kidney functions, and coagulation profile. Radiological investigations included computerized tomography (CT). The patients were followed, both clinically using the NIHSS score, radiologically with CT brain after 1 week and 4 weeks from the onset to assess the hematoma growth, its complications, and or resolution. Modified Rankin score (mRS) was done after 30 days of onset to assess patient’s disability. Results: The 30-day mortality was about one third of the patients. The intracerebral hematoma volume on admission has a significant positive correlation with the NIHSS, and ICH score significantly correlates with the 30- day outcome. Conclusion: Admission NIHSS has an independent predictive value of the 30-day outcome in cases of primary ICH as regards mortality and disability. Keywords: Primary intracerebral hemorrhage, Outcome, NIHSS score