Article Text

Download PDFPDF
Neurofilament light chain levels in ventricular cerebrospinal fluid after acute aneurysmal subarachnoid haemorrhage
  1. E R Zanier1,2,
  2. D Refai3,
  3. G J Zipfel3,
  4. T Zoerle1,
  5. L Longhi1,
  6. T J Esparza4,
  7. M L Spinner4,
  8. R J Bateman4,
  9. D L Brody4,
  10. N Stocchetti1
  1. 1Department of Anesthesia and Critical Care Medicine, University of Milan, Neurosurgical Intensive Care Unit, Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Milan, Italy
  2. 2Mario Negri Institute for Pharmacological Research, Milan, Italy
  3. 3Department of Neurosurgery, Washington University School of Medicine, Saint Louis, Missouri, USA
  4. 4Department of Neurology and Hope Center for Neurological Disorders, Washington University School of Medicine, Saint Louis, Missouri, USA
  1. Correspondence to David L Brody, Department of Neurology, Washington University School of Medicine, 660 S. Euclid Avenue, Campus Box 8111, Saint Louis, MO 63110, USA; brodyd{at}


Purpose The contribution of axonal injury to brain damage after aneurysmal subarachnoid haemorrhage (aSAH) is unknown. Neurofilament light chain (NF-L), a component of the axonal cytoskeleton, has been shown to be elevated in the cerebrospinal fluid of patients with many types of axonal injury. We hypothesised that patients with aSAH would have elevated cerebrospinal fluid (CSF) NF-L levels and sought to explore the clinical correlates of CSF NF-L dynamics.

Methods Serial ventricular CSF (vCSF) samples were collected from 35 patients with aSAH for up to 15 days. vCSF NF-L measurements were determined by enzyme-linked immunosorbent assay. NF-L levels were analysed in relation to acute clinical status, radiological findings and 6-month outcomes.

Results vCSF NF-L concentrations were elevated in all patients with aSAH. Patients with early cerebral ischaemia (ECI), defined as a CT hypodense lesion visible within the first 3 days, had higher acute vCSF NF-L levels than patients without ECI. These elevated NF-L levels were similar in patients with ECI associated with intracranial haemorrhage and ECI associated with surgical/endovascular complications. vCSF NF-L levels did not differ as a function of acute clinical status, clinical vasospasm, delayed cerebral ischaemia or 6-month Glasgow Outcome Scale.

Conclusions Elevated vCSF NF-L levels may in part reflect increased injury to axons associated with ECI. However, our results suggest that axonal injury after aSAH as reflected by release of NF-L into the CSF may not play a major role in either secondary adverse events or long-term clinical outcomes.

  • Cerebral aneurysm
  • subarachnoid haemorrhage
  • biomarker
  • neurofilament
  • axonal injury
  • neurochemistry
  • stroke
  • subarachnoid haemorrhage

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Funding Other funders: NIH; Burroughs Wellcome, Thrasher Research Fund.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the University of Milan and Washington University.

  • Provenance and peer review Not commissioned; externally peer reviewed.