NEUROFILAMENT LIGHT CHAIN IN ISCHEMIC STROKE: TEMPORAL DYNAMICS, ASSOCIATION WITH DISEASE SEVERITY AND PROGNOSIS (LITERATURE REVIEW)
Keywords:
ischemic stroke, neurofilament light chain, NfL, sNfL, pNfL, neuroaxonal injury, biomarker, stroke severity, functional outcome, prognosisAbstract
Ischemic stroke remains one of the leading causes of death and persistent disability, highlighting the need for objective biomarkers of brain injury and disease prognosis. Neurofilament light chain (NfL) is a structural protein of the axonal cytoskeleton whose concentration increases in response to neuroaxonal damage. The development of highly sensitive methods for detecting NfL in blood has expanded the possibilities for its investigation in ischemic stroke. The aim of this review is to analyze and synthesize current evidence on the temporal dynamics of NfL and its association with ischemic stroke severity, infarct volume, and functional outcomes. Original studies, systematic reviews, and meta-analyses published mainly between 2020 and 2026 were analyzed, with a literature search conducted in the PubMed, Scopus, and Web of Science databases. The reviewed studies indicate that NfL concentrations increase following ischemic stroke and are associated with the severity of neurological deficits. Several studies have also demonstrated an association between NfL levels, infarct volume, and adverse functional outcomes. However, the clinical value of this biomarker depends substantially on the timing of its measurement. According to the largest individual participant data meta-analysis published in 2026, NfL concentrations progressively increased during the first week after stroke, reaching the highest levels approximately on days 6–7. Higher NfL levels, particularly during the subacute period, are associated with unfavorable functional outcomes and an increased risk of mortality. NfL may be considered a promising biomarker of neuroaxonal injury in ischemic stroke; however, its implementation in clinical practice requires standardization of measurement timing and further assessment of its prognostic value in prospective studies.
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