Measurement of GFAP in Nasal Exudate in the Differential Diagnosis between Ischemic Stroke and Intracerebral Hemorrhage

Cerebrovasc Dis. 2024;53(5):515-518. doi: 10.1159/000534693. Epub 2023 Oct 25.

Abstract

Background: Differential diagnosis between ischemic stroke (IS) and intracerebral hemorrhage (ICH) is a great challenge. Recently, the discovery of cerebral lymphatic drainage toward the nostrils suggested nasal exudate (NE) as a new source for measuring biomarkers from neural damage.

Objectives: In this study, we sought to confirm whether glial fibrillary acidic protein (GFAP) levels in NE could identify ICH.

Methods: GFAP in nasal exudate (nGFAP) was studied in 5 IS and 5 ICH patients. All patients underwent neurological examination, brain computed tomography, laboratory tests, and measurement of nGFAP and serum GFAP.

Results: We found higher concentrations in ICH patients (p = 0.02). The area under the ROC curve for IS/ICH discrimination was 0.840, with a cut-off point of 0.06 pg/mg for 100% sensitivity and 80% specificity.

Conclusions: These findings suggest that nGFAP could be a useful biomarker for differential diagnosis between IS and ICH and opens a potential field of study for other biomarkers in NE in neurological disorders.

Keywords: GFAP; Glymphatic system; Intracerebral hemorrhage; Ischemic stroke; Nasal exudate.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Biomarkers* / blood
  • Cerebral Hemorrhage* / blood
  • Cerebral Hemorrhage* / diagnosis
  • Cerebral Hemorrhage* / diagnostic imaging
  • Diagnosis, Differential
  • Exudates and Transudates / chemistry
  • Female
  • Glial Fibrillary Acidic Protein* / analysis
  • Glial Fibrillary Acidic Protein* / blood
  • Humans
  • Ischemic Stroke* / blood
  • Ischemic Stroke* / diagnosis
  • Ischemic Stroke* / metabolism
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Up-Regulation

Substances

  • Biomarkers
  • GFAP protein, human
  • Glial Fibrillary Acidic Protein