Herpes simplex virus is the most common cause of sporadic encephalitis. However, the diagnosis can be challenging in atypical cases. Without prompt treatment, the morbidity and mortality is high. We report a case of herpes simplex encephalitis (HSE) in a 23-year-old man presenting with an intracerebral hematoma. After an anatomical etiology was ruled out, acyclovir was started. Later, polymerase chain reaction of the cerebrospinal fluid was positive for herpes simplex virus-1. We review previously reported cases of HSE with ICH, as well as other atypical presentations of HSE.