Objective To investigate the relationship between the neutrophil-to-lymphocyte ratio (NLR) and the risk of cerebral microbleeds (CMBs) in the general population.Methods Clinical data from consecutively enrolled patients attending the neurology department were retrospectively analyzed. According to neuroimaging findings, participants were divided into CMB and non-CMB groups. Clinical and biochemical characteristics were compared between the two groups. Patients were further stratified into tertiles based on NLR levels, and the incidence of CMBs among different tertiles was compared. Spearman correlation analysis, multivariate binary logistic regression analysis, and Kaplan-Meier curves were used to explore and visualize the trend of CMB occurrence across different NLR levels. Results CMBs were identified in 10.1% (127/1,259) of patients. Compared to those without CMBs, patients with CMBs exhibited significant differences in systolic and diastolic blood pressure, body weight, body mass index (BMI), history of diabetes, hyperuricemia, carotid artery plaque, use of antidiabetic medications, platelet count, neutrophil count, NLR, uric acid, and low-density lipoprotein cholesterol (all P<0.05). NLR was significantly positively correlated with CMB occurrence (r=0.162, P<0.001). Multivariate logistic regression analysis showed that NLR remained a significant predictor of CMB risk, both before and after adjusting for confounding factors (unadjusted OR=1.295, 95% CI:1.182~1.418, P< 0.001; adjusted OR=1.169, 95% CI:1.077~1.268, P<0.001). Kaplan-Meier analysis revealed a progressively increasing cumulative risk of CMBs with higher NLR levels, with no significant difference between sexes (P=0.85). Conclusion Elevated NLR is significantly associated with an increased risk of CMBs, suggesting that NLR is an important risk factor for CMB development. These findings underscore the potential value of NLR as a biomarker for the early identification of individuals at risk for CMBs