A263 Clinical and imaging perspectives on hemorrhagic stroke: enhancing one-stop stroke management

<h3>Introduction</h3> One-stop-management workflows using flat panel detector CT (FDCT) can significantly reduce the time to treatment in acute stroke patients, yet their implementation is limited by concerns regarding the differentiation of ischemic and hemorrhagic strokes. <h3>Aim of Study</h3> This study examines the imaging characteristics of spontaneous intracranial hemorrhage (ICH) across National Institute of Health Stroke Scale (NIHSS) severity groups. This data will be important for the planning of future trials evaluating one-stop management approach. <h3>Method</h3> We performed a retrospective analysis of patients with imaging-confirmed spontaneous ICH admitted between January 2020 and December 2022. Hemorrhages were categorized by location, hematoma volume, and secondary extension. Primary outcomes included hemorrhage volume distribution across NIHSS severity groups (NIHSS &lt;7 vs. NIHSS ≥7) and the frequency of secondary extension. Secondary analyses assessed characteristics of isolated infratentorial hemorrhages and clinical outcomes at three months. <h3>Results</h3> Among 396 patients, the NIHSS ≥7 group had significantly larger hemorrhages (median 38 ml vs. 6 ml, p &lt; 0.001) and more frequent secondary extension (43% vs. 6%). In isolated infratentorial hemorrhages (n = 25), lesion location, rather than volume, determined clinical severity. Brainstem hemorrhages were more common in NIHSS ≥7 patients (70%), while cerebellar hemorrhages were more frequent in NIHSS &lt;7. Logistic regression indicated that brainstem location independently predicted NIHSS ≥7 (OR = 11.96, p = 0.047), while hemorrhage volume was not significant. <h3>Conclusion</h3> In summary, hemorrhage volume was significantly larger in NIHSS ≥7, with isolated infratentorial hemorrhage severity dependent on anatomical location. Brainstem hemorrhages were more prevalent and detectable in severe cases. <h3>Conflict of Interest</h3> No