Phosphorylated Neurofilament H as a Diagnostic Marker in Acute Brain Insults

Background and Purpose: One of the main drawbacks in the management of patients with acute brain injuries is the absence of a widely available and rapid diagnostic test. The objective of our study was to assess whether Phosphorylated Neurofilament H (pNF-H) might provide useful diagnostic information and weather levels of the neurofilament correlated with different clinical variables. Methods: A total of 90 patients presenting to the Critical Care Department of Cairo University were prospectively studied. Patients were stratified according to the presenting pathology into 3 main groups: Traumatic Brain Injury, Ischemic Stroke and Cerebral Hemorrhage. Blood samples for phosphoryalted neurofilament H were assayed on admission and after 7 days. Neurofilament levels were correlated to Glasgow coma scale, CT findings and NIHSS on admission and after 7 days Rankin score at 3 months was used to detect the degree of disability. Results: Neurofilament H levels showed a negative correlation with GCS on admission and after 7 days in traumatic brain injury (r=0.66 0.78, respectively), ischemic stroke (r=0.3 0.5, respectively) and cerebral hemorrhage (r=0.56 0.65, respectively). In traumatic brain injury patients, there were a negative correlation between neurofilament levels and Marshal CT scores on admission and after 7 days (r=0.56 0.4, respectively) hence higher neurofilament levels correlated with worse CT findings. In ischemic CVS, there were a negative correlation between neurofilament levels and AS-PECTS CT scores (r=0.64 0.89, respectively). In both ischemic CVS and cerebral hemorrhage, NIHSS showed positive correlations with neurofilament levels patients who died or had the greatest scores (Rankin 6 5) after 3 months had the highest levels of Neurofilamnent on admission and after 7 days. The cut off level of Neurofilament to detect death and disability was 35pg/ml on admission (sensitivity 82%, specificity 78%) and was 1 1pg/ml after 7 days (sensitivity 87%, specificity 92%). Conclusion: Phosphorylated Neurofilament H can be used as a diagnostic and prognostic marker in patients with acute brain insults as seen by the presence of significant correlations between the marker levels and different clinical and radiological tools.