To determine whether cerebrospinal fluid (CSF) profiling of neuronal injury biomarkers can reliably distinguish SCS from inflammatory and compressive myelopathies to enable faster and accurate diagnosis.
Spinal cord stroke (SCS) is a severe neurological condition caused by disrupted blood flow to the spinal cord, leading to motor and sensory disruptions. Its early presentation often mimics other spinal cord pathologies such as myelitis, which complicates timely diagnosis and treatment. They carry a high risk of permanent disability and impose long-term medical, social, and economic burdens.
CSF samples from SCS, AQP4-positive neuromyelitis optica (NMO), Myelin Oligodendroglial Glycoprotein Antibody Disease (MOGAD), compressive myelopathies, and non-inflammatory controls (NIC) were analyzed to measure neuronal injury markers using ELLA®, a multiplexed array assay. This platform was selected for its reproducibility and ability to detect the low-abundance CNS neurofilament light chain (NFL) and glial fibrillary acidic protein (GFAP). All CSF samples were diluted at a 1:2 ratio. Results were analyzed with the Kruskal-Wallis test for multiple group comparisons. Pairwise-comparison was done to understand differences between groups.
CSF from SCS have the highest measurements for both NFL and GFAP. Inflammatory-and mechanical-associated myelopathies generally show higher NFL, while GFAP values remain low. NMO has high GFAP values, whereas the NFL range is significantly lower than that in stroke cases. NIC groups have low GFAP and NFL, as expected. These differences were statistically significant. (Kruskal-Wallis, p = 0.042 for GFAP and p < 0.0001 for NFL). Dunn's test supported that SCS had higher NFL and GFAP values than NIC.
NFL and GFAP in CSF may provide clues about diagnosis in inflammatory and vascular-associated myelopathies, specifically changes that reflect differences in pathophysiology processes associated with neuronal and astrocytic injury across diagnostic groups. Further investigation of vascular injury biomarkers and cytokines in CSF would provide clues on biomarkers of disease and outcomes.