ABSTRACT NUMBER: ESOC2026A314 CHARACTERIZATION OF INTRACEREBRAL HEMORRHAGE PATIENTS WITH MIXED LOCATION HEMORRHAGES: CLINICAL AND IMAGING FEATURES, CSF NEURODEGENERATION MARKERS AND RECURRENCE RISK

Abstract Background and aims The most frequent causes of intracerebral hemorrhage (ICH) include arteriolosclorotic small vessel disease (ICH-aSVD) and cerebral amyloid angiopathy (ICH-CAA). The predominant underlying pathology and natural history of ICH patients with mixed deep and lobar location hemorrhages (ICH-MLH) remains poorly studied. Methods We performed a retrospective analysis of consecutive patients with ICH admitted between 2018-2024 and selected patients without macrostructural cause of hemorrhage, with available magnetic resonance imaging. We compared clinical characteristics, imaging markers, cerebrospinal fluid (CSF) neurodegeneration markers and ICH recurrence in patients with ICH-CAA, ICH-MLH and ICH-aSVD. Results We included 231 patients (ICH-CAA = 101, ICH-MLH = 79, ICH-aSVD = 51), median age was 72 years (interquartile range [IQR] = 61-80), and 94 patients were female (40.7%). ICH-MLH patients were younger than ICH-CAA patients (P = 0.008) but older than ICH-aSVD patients (P = 0.012). Absence of cortical superficial siderosis, absence of severe burden of enlarged perivascular spaces (EPVS) in the centrum semiovale, presence of severe burden of EPVS in the basal ganglia, presence of cerebellar microbleeds, and presence of deep lacunes of presumed vascular origin where independently associated with ICH-MLH. ICH-MLH patients had higher CSF amyloid β42 (median 719 versus 363 pg/mL, P < 0.001) and amyloid β40 levels (median 9124 versus 6958 pg/mL, P = 0.010) than ICH-CAA patients. ICH recurrence was higher in ICH-CAA (7.9 per 100 person-years), followed by ICH-MLH (5.8 per 100 person-years) and ICH-aSVD (1.4 per 100 person-years) (P = 0.163). Conclusions Neuroimaging features and CSF neurodegeneration markers in ICH-MLH suggest that arteriolosclerotic pathology is predominant in most cases. Conflict of interest João Pinho: nothing to disclose. Ana Sofia Costa: nothing to disclose. Iason Bartzokis: nothing to disclose. Alma De Angelis: nothing to disclose. Charlotte Weyland: nothing to disclose. Martin Wiesmann: nothing to disclose. Kathrin Reetz: nothing to disclose. Jörg B. Schulz: nothing to disclose. Arno Reich: nothing to disclose.