ABSTRACT NUMBER: ESOC2026A2227 CLINICAL AND IMAGING FEATURES OF PATIENTS WITH INTRACEREBRAL HEMORRHAGE AND ACUTE SYMPTOMATIC SEIZURES – A MULTICENTER ANALYSIS

Abstract Background and aims Acute symptomatic seizures pose a common complication in the early treatment phase of spontaneous intracerebral hemorrhage (ICH). Data on which patients are at an increased risk of an acute symptomatic seizure are scarce. The aim of this study was to characterize patients with vs. without acute symptomatic seizures in ICH. Methods We retrospectively analyzed all patients with spontaneous ICH admitted to three tertiary care hospitals in Berlin, Germany 2018-2023. We compared demographic, clinical and imaging data of ICH patients with acute symptomatic seizure with those without acute symptomatic seizure. Results We included 369 ICH patients (mean age 70.2 years, median NIHSS 6, 52.3% female) of which 44 (11.9%) had an acute symptomatic seizure. Frontal ICH was associated with more frequent acute symptomatic seizures (OR=2.0, 95% CI 0.9-4.1), whereas seizures occurred significantly less frequently in strictly deep ICH (OR=0.4, 95% CI 0.2-0.9) Patients with acute symptomatic seizure had significantly more lobar CMBs (cerebral microbleeds) (3 (IQR: 1-16) vs. 1 (IQR: 0-4); p=0.008). Moreover, patients with acute symptomatic seizure were more severely affected compared to those without seizure concerning consciousness and stroke-related impairments (GCS 12 (IQR: 9-15) vs.15 (IQR: 11-15); p=0.05; NIHSS 10 (IQR: 5-17) vs. 5 (IQR: 2-10); p=0.02). Conclusions About 1 in 8 spontaneous ICH patients will have an acute symptomatic seizure (<7d). Patients with strictly deep ICH are at decreased risk. In addition, lobar CMBs seem to affect the risk for acute symptomatic seizure. Further research is needed to clarify the role of CMBs in spontaneous ICH and acute symptomatic seizure. Conflict of interest Thea Hüsing: received travel and accommodation costs from Jazz Pharmaceuticals. Christian Nolte: received honoraria for lectures/advisory board from AstraZeneca, Bayer and Pfizer. Martin Holtkamp: received honoraria for lectures from Angelini, Bial, Danone, Desitin, Eisai, Jazz Pharma, Neuraxpharm und UCB. Heinrich J. Audebert: received honoraria for lectures/advisory boards from AstraZeneca, Bayer, BMS, Boehringer and Pfizer. Noah Ayadi: nothing to declare. Jakob I. Doerfuss: nothing to declare. Sophie L. Böhme: nothing to declare. Bernd J. Vorderwülbecke: nothing to declare.