Intracerebral hemorrhage in the brain is the most common complication of hypertension, aneurysmal rupture, or vascular malformation. The occurrence of symmetrically bilateral intracerebral hemorrhage is an unusual clinical event that develops in only a small percentage of all patients who have intracerebral hemorrhage. Even though, the size of contralateral hemorrhage is not too large, majority of patients with bilateral intracerebral hemorrhage in basal ganglia or thalamus have generally a poor outcome. In all cases of this report, the contralateral intracerebral hemorrhage was resulted from an inadequate control of hypertension. Therefore, optimal control of blood pressure must be considered as the most important treatment option to prevent recurrence. Authors report the characteristic clinical and radiologic features of four cases in which mirror-image bilateral intracerebral hemorrhage occurred.