ABSTRACT NUMBER: ESOC2026A1587 FACTORS OTHER THAN HYDROCEPHALUS ARE NEEDED TO EXPLAIN THE ASSOCIATION BETWEEN INTRAVENTRICULAR HEMORRHAGE AND GAIT DYSFUNCTION AND INCONTINENCE

Abstract Background and aims Intraventricular hemorrhage (IVH) complicates approximately 40% of spontaneous intracerebral hemorrhages (ICH). We previously reported that IVH associates with long-term gait dysfunction and incontinence independent of severity. We evaluated MRI metrics of hydrocephalus for association with these outcomes. Methods The Recovery and Outcomes after Stroke (ROSE) study obtained diffusion tensor imaging (DTI) at presentation after ICH. Paraventricular corticospinal (pvCST) fiber characteristics of curl, radius, and elongation were analyzed. Curl is tract length divided by distance between its endpoints, radius calculation uses circular end-surface modeling, and elongation is tract length divided by diameter. Univariate and multivariate analyses evaluated associations between imaging characteristics and 3-month outcomes. Results Among 162 ICH patients, 55 (34%) had IVH. IVH patients had larger hematomas, lower Glasgow Coma Scale scores, increased immobility (53% vs 22%) and incontinence (47% vs 24%) at follow-up. Curl was greater in the IVH group (6.0 ± 0.2 vs 5.8 ± 0.2, p = 0.00004) but not independently associated with incontinence or gait dysfunction in multivariate analysis (n = 43; immobility (p = 0.82); incontinence (p = 0.11)). Radius was lower in the IVH group (16.6 ± 3.4 vs 17.8 ± 3.1, p = 0.04) with suggestive association with gait dysfunction (p = 0.05) warranting further study. Elongation was not different between groups. Conclusions IVH is associated with incontinence and immobility but not with hydrocephalus markers by DTI. This negative finding suggests excellent hydrocephalus prevention and that associations with incontinence and immobility are not from CST stretching. Alternative explanations such as periventricular inflammation should be explored. Conflict of interest Spencer Maranto: nothing to disclose; Miranda C. Marion: nothing to disclose; Colin L. Speer: nothing to disclose; Elisha Jindal: nothing to disclose; Mahim Mahim: nothing to disclose; Stacie Demel: nothing to disclose; Rosalind Lai: nothing to disclose; Adnan Siddiqui: nothing to disclose; Carl D. Langefeld: nothing to disclose; Daniel Woo: nothing to disclose