BACKGROUND Hydrocephalus secondary to hypertensive intracerebral hemorrhage (HICH) dramatically affects the prognosis. Early enteral nutrition (EN) is beneficial to severe HICH patients, but the impact of early EN administration on hydrocephalus remains unknown. This study aimed to explore the predictors for hydrocephalus occurrence after HICH, with special focus on the effect of early EN application. MATERIAL AND METHODS We retrospectively analyzed 146 patients with severe HICH who underwent microsurgery between January 2014 and October 2019 in our department. Patients were divided into early EN (≤48 h) and delayed EN (>48 h) group according to the time-point of EN administration. The diagnosis of hydrocephalus was confirmed by both radiological evaluation and an Evan index method. Diagnosis confirmed within 2 weeks after HICH was identified as acute hydrocephalus, otherwise, it was considered as chronic hydrocephalus. RESULTS Twenty-seven patients experienced acute hydrocephalus, while 20 patients developed chronic hydrocephalus. Low preoperative Glasgow coma scale (GCS), subarachnoid hemorrhage (SAH), intraventricular hemorrhage (IVH), delayed EN administration, high levels of postoperative white blood cell, neutrophil, neutrophil-to-lymphocyte ratio, C-reactive protein (CRP), and lactate dehydrogenase were positively related to the occurrence of chronic hydrocephalus (p<0.05), while only IVH was correlated with acute hydrocephalus occurrence (p<0.05). In addition, a multivariate analysis demonstrated that preoperative GCS, SAH, IVH, and early EN administration (p<0.05) were independent predictors for chronic hydrocephalus occurrence. CONCLUSIONS Early EN administration, SAH, IVH, and preoperative GCS were associated with the occurrence of chronic hydrocephalus in severe HICH patients. Early EN administration may inhibit the inflammatory response of brain-gut axis, which in turn reduces chronic hydrocephalus occurrence.