Lakhasly

In the current study we aimed to measure NfL levels in patients with acute cerebrovascular stroke either ischemic or hemorrhagic in the general population from South of Egypt (Aswan), in comparison with healthy controls as well as to clarify its association with the stroke severity, etiology, risk factors, types and with stroke functional outcome in our studied patients.In ischemic patients, median NFL was 470.75 with IQR = 327.25 - 542.5 while in hemorrhagic patients, median NFL was 453 with IQR = 336 - 527.5 Using ROC curve, it was shown that serum NFL can be used to discriminate between Cases and Controls at a cutoff level > 195, with 100% sensitivity, 100% specificity, 100% PPV and 100% NPV (AUC = 1.0 & p-value < 0.001).We found no statistically significant correlation between median NFL level and risk factors (sex, smoking, DM., HTN, cardiac and dyslipidemia) (p-value = 0.492, 0.929, 0.667, 0.306, 0.079 and 0.252 respectively), despite these results we observed high levels of NfL levels on those patients who were diabetic, hypertensive, cardiac or had dyslipidemia.In patients with hemorrhagic stroke, there were statistically significant correlation between increased NFL level and presence of intraventricular extension (median = 530.5, IQR = 466.7 - 621, p-value = 0.002) (Figure 17) as well as hemorrhage volume >= 30 ml (median = 527.55, IQR = 466.5 - 563.5, p-value < 0.001).77 patients (90.6%) had stroke due to anterior circulation and 9 patients (9.4%) had stroke due to posterior circulation According to TOAST classification; large artery atherosclerosis and small vessel occlusion were the etiology of ischemic stroke in 22 patients (51.2%) and 13 patients (30.2%) respectively while in 7 patients (16.3%), the etiology was cardio embolism.In patients with Ischemic stroke, there was high statistically significant correlation between NFL level and severe degree of weakness (hemiplegia) (median = 500, IQR = 450 - 568, p-value < 0.001).For that we enrolled 85 patients with first-ever acute onset cerebrovascular stroke (either ischemic or hemorrhagic types) and age- and sex-matched apparently healthy subjects as normal controls.high statistically significant correlation between NFL level and large artery atherosclerosis as a cause for Ischemic stroke (median = 522, IQR = 494.5 - 647.2, p-value < 0.001).

In the current study we aimed to measure NfL levels in patients with acute cerebrovascular stroke either ischemic or hemorrhagic in the general population from South of Egypt (Aswan), in comparison with healthy controls as well as to clarify its association with the stroke severity, etiology, risk factors, types and with stroke functional outcome in our studied patients. For that we enrolled 85 patients with first-ever acute onset cerebrovascular stroke (either ischemic or hemorrhagic types) and age- and sex-matched apparently healthy subjects as normal controls.
as Regarding age, the mean age was 59.05 ± 15.4 years (with range of 20 - 88 years; median age = 60 years). The male sex was predominating (48 males; 56.5%) in the studied patients. 28 patients were smokers (32.9%). Regarding risk factors, there were 32 patients (37.6%) had DM, 63 patients (74.1%) had HTN, 39 patients (45.9%) had dyslipidemia and 7 patients (8.2%) had non-valvular AF, 2 patients (2.4%) had IHD.
As Regarding the stroke type, 50 patients (58.8%) had ischemic stroke while 35 patients (41.2%) had hemorrhagic stroke. Hemiplegia was the clinical presentation of 55 patients (64%) whereas 30 patients (35.3%) presented by hemiparesis. 77 patients (90.6%) had stroke due to anterior circulation and 9 patients (9.4%) had stroke due to posterior circulation According to TOAST classification; large artery atherosclerosis and small vessel occlusion were the etiology of ischemic stroke in 22 patients (51.2%) and 13 patients (30.2%) respectively while in 7 patients (16.3%), the etiology was cardio embolism. We had 35 patients with intracerebral hemorrhage, Supratentorial location of hemorrhage was noticed in 34 patients (97.1%) while infratentorial location was seen in one patient only (2.9%). 26 patients had intraventricular extension (74.3%). Regarding hemorrhage volume, 15 patients had a volume ≥ 30 ml (42.9%).
as Regarding NIHSS score, 13 (15.3%) and 66 (77.6%) patients had mild and moderate scores respectively. Only 6 patients (7.1%) had severe NIHSS score. Concerning MRS, there were 8 patients (9.4%) with no significant disability, 16 patients (18.8%) with slight disability, 16 patients (18.8%) with moderate disability, 32 patients (37.6%) with moderately severe disability and 13 patients (15.3%) with severe disability.
The mean NFL levels was 433.1 ± 149.8 (with range; 203 – 1125). There were 50 patients (58.8%) had levels of NFL > 400 pg/ml while 35 patients (41.2%) had NFL levels 200-400 pg/ml.
highly statistically significant increased NFL level in Cases (median = 456, IQR = 333 – 530.25) when compared with Controls (median = 150, IQR = 137.5 - 170) with p-value < 0.001. Most of our cases (50 patients; 58.8%) had serum levels of NFL > 400 pg/ml.

no statistically significant (p-value > 0.05) difference between ischemic and hemorrhagic patients as regard NFL level. In ischemic patients, median NFL was 470.75 with IQR = 327.25 – 542.5 while in hemorrhagic patients, median NFL was 453 with IQR = 336 – 527.5
Using ROC curve, it was shown that serum NFL can be used to discriminate between Cases and Controls at a cutoff level > 195, with 100% sensitivity, 100% specificity, 100% PPV and 100% NPV
(AUC = 1.0 & p-value < 0.001).
the Correlation between NFL level and demographic data and risk factors in studied Cases. We found no statistically significant correlation between median NFL level and risk factors (sex, smoking, DM., HTN, cardiac and dyslipidemia) (p-value = 0.492, 0.929, 0.667, 0.306, 0.079 and 0.252 respectively), despite these results we observed high levels of NfL levels on those patients who were diabetic, hypertensive, cardiac or had dyslipidemia.
In patients with Ischemic stroke, there was high statistically significant correlation between NFL level and severe degree of weakness (hemiplegia) (median = 500, IQR = 450 – 568, p-value < 0.001). On the other hand, no statistically significant correlation between NFL level and type of affected circulation nor stroke type with p-value = 0.065 and 0.553 respectively.
In patients with hemorrhagic stroke, there were statistically significant correlation between increased NFL level and presence of intraventricular extension (median = 530.5, IQR = 466.7 – 621, p-value = 0.002) (Figure 17) as well as hemorrhage volume ≥ 30 ml (median = 527.55, IQR = 466.5 – 563.5, p-value < 0.001).

statistically significant Positive correlation between NFL and age (r = 0.24, p-value = 0.022). Otherwise, no statistically significant correlations between NFL and ICH score.
there was high statistically significant correlation between NFL level and stroke severity assessed by NIHSS and stroke outcome assessed by MRS (p-value < 0.001 respectively).
high statistically significant correlation between NFL level and large artery atherosclerosis as a cause for Ischemic stroke (median = 522, IQR = 494.5 – 647.2, p-value < 0.001).