Objective To explore the application value of multi-slice spiral CT in the treatment of elderly patients with cerebral hemorrhage complicated with coma in intensive care unit (ICU). Methods A total of 49 cases of elderly patients with cerebral hemorrhage accompanied by coma in Department of Neurosurgery 24h in July 2013 -2015 July were selected as the research objects, and the relationship between CT manifestations and prognosis of ICU was analyzed. Results Among the 49 cases, 15 cases with cerebral hematoma complicated with coma died, accounting for 30.61%. The most common area of hematoma was basal ganglia (55.10%). 31 cases of hematoma was regular (63.27%), and 18 cases were irregular (36.73%). The bleeding volume of 26 cases (53.06%) was < 30mL, 14 cases (28.57%) 30-60mL and 9 cases (18.37%) ＞ 60mL. The mortality rates were 11.54%, 35.71% and 77.78% respectively. There were 20 cases without midline shift (40.82%), 16 cases with midline shift ≤ 5mm (32.65%), 9 cases with midline shift 6 to 10mm (18.37%) and 4 cases with shift ＞ 10mm (8.16%). The mortality rates were 10.0%, 31.25%, 55.56% and 75.0%, respectively. Conclusion Multi-slice spiral CT can clearly show the location, volume of hematoma, and whether the middle line shift in elderly patients with craniocerebral injury and coma.