ABSTRACT NUMBER: ESOC2026A2201 SUBCORTICAL STROKE LESIONS ARE ASSOCIATED WITH RESTLESS LEGS SYNDROME AND GREATER SYMPTOM SEVERITY

Abstract Background and aims The neuroanatomical correlated underlying restless legs syndrome (RLS) in stroke patients are poorly defined. Subcortical structures involved in dopaminergic sensorimotor modulation are central to RLS pathophysiology and may influence both symptom occurrence and severity following stroke. The aim of this study is to examine stroke lesion topography and its relationship with RLS presence and symptom severity in patients with acute cerebrovascular events. Methods Patients admitted with ischemic stroke, hemorrhagic stroke or transient ischemic attack were screened for RLS using International Restless Legs Syndrome Study Group criteria. Lesion location was determined from neuroimaging and classified as subcortical or cortical. RLS symptom severity was assessed using the IRLSSG severity scale. Analyses focused in lesion distribution, stroke subtype, and severity patterns among patients with RLS. Results Of 754 patients with acute stroke, 105 (13.9%) were diagnosed with RLS. Most RLS cases occurred in ischemic stroke (92/105, 87.06%), followed by hemorrhagic stroke (11/105, 10.5%) and transient ischemic attack (2/105, 1.9%). Subcortical lesions were identified in 91 patients with RLS (86.7%), whereas isolated cortical lesions were uncommon (13.3%). Patients with subcortical stroke involvement exhibited higher RLS severity scores compared to those with cortical lesions. Conclusions RLS in acute stroke is strongly associated with subcortical lesion involvement and appears more severe when subcortical structures are affected. These findings support a network- based model implicating disruption of dopaminergic sensorimotor pathways rather than cortical injury alone, and highlight lesion topography as a determinant of RLS clinical expression after stroke. Conflict of interest Nothing to disclose