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Background: There is conflicting evidence about the influence of sex on outcome after spontaneous intracerebral hemorrhage (sICH) and the majority of the research focused on mortality and short-term outcome only. We investigated sex differences in long-term functional outcome after sICH. Methods:We used data from a prospective hospital registry and included all consecutive patients with ICH admitted to our institution between January 2006 and July 2014. Functional outcome was assessed by modified Rankin Scale evaluated 3 and 12 months after ICH. We explored the influence of sex on long-term functional outcome using multivariable regression models and additionally by means of propensity score matching. Results:We analyzed 823 patients, of whom 380 (46%) women. Women were on average three years older (p<0.001), men had more often deep hematomas (p=0.01). Unadjusted mortality rates were significantly increased in women at three months (42% vs. 35%; odds ratio (OR): 1.35; 95% confidence interval (CI): 1.02-1.80). After adjusting for baseline prognostic factors there were no differences between men and women in short- and long-term mortality (OR=1.01; 95% CI=0.66-1.54 and OR=1.04; 95%CI=0.69-1.57, respectively) and short- and long-term unfavorable outcome (OR=1.02; 95%CI=0.67-1.55 and OR=0.96; 95% CI=0.62-1.48, respectively). Conclusion: We found no sex-related differences in long-term functional outcome in patients with sICH. The apparently worse functional outcome in women can be explained by differences in age. [ABSTRACT FROM AUTHOR]