Twenty-three adults who had evidence of intraventricular hemorrhage were identified, and their charts were reviewed. Thirteen patients died and 10 survived. Eleven of the 13 who died were hypertensive. All had severe neurological deficit and evidence of brain stem dysfunction at the time of admission and progressed rapidly to coma and death. Two of the survivors had periventricular arteriovenous malformations. They presented neurologically intact and remained so. The other eight survivors had a distinct clinical course. They presented with focal deficits and abnormalities of mental status. These persisted, and at follow-up 3 to 20 months later they all had profound deficits of recent memory and intellect, and none was capable of daily self-care. Computerized tomographic (CT) scans were not useful in predicting outcome. The presence of parenchymal clot, multiple chamber involvement, 3rd ventricular involvement, ventriculomegaly, and midline shift were seen in all groups. Illustrative examples are presented.