Brain shrinkage

Müller M, Esser R, Kötter K, Voss J, Müller A, Stellmes P.Third ventricular enlargement in early stages of multiple sclerosis is a predictor of motor and neuropsychological deficits: a cross-sectional study. BMJ Open. 2013 Sep 10;3(9):e003582. doi: 10.1136/bmjopen-2013-003582.
OBJECTIVES:Whether transcranal sonography (TCS) depicted third ventricular enlargement as a sign of brain atrophy is predictive for neuropsychological deficits in mildly affected patients with multiple sclerosis (MS).
PARTICIPANTS: Fifty-four patients with MS (16 men, 38 women, mean age 40±10 years, mean disease duration 6±5 years; mean Expanded Disability Status Scale 2±1.3) and 33 healthy controls (12 men, 21 women; 38±11 years) underwent clinical examination, an assessment of the third ventricle width by means of TCS and the Brief Repeatable Battery of Neuropsychological tests for MS, the 25-Feet Foot Walk test, the 9-Hole PEG test, the Beck Depression Inventory and a quantitative fatigue assessment. Statistical analysis was performed with univariate correlation and thereafter by stepwise regression analysis.
RESULTS: Patients' mean third ventricular width (3.9±1.6 mm) was significantly wider compared to controls (3.4±0.8 mm). MS duration, third ventricle width and quantitative fatigue assessment as baseline variables, an increasing third ventricle width significantly correlated with the target variables worsening of motor deficits (p<0.002), worsening of verbal recall (p<0.04) and of visual spatial recall (p<0.005). Severity of depression and of fatigue was unrelated to third ventricular width.
CONCLUSIONS: In this cohort of patients with MS with mild disease, third ventricular enlargement was indicative for motor deficits and cognitive impairment, even after considering fatigue as a relevant comorbidity. Third ventricular enlargement by means of TCS seems to be a useful, clinically meaningful parameter to stage patients' disease severity. Follow-up studies must show whether an intra individual future third ventricular increase indeed signals larger cognitive impairment.
The brain ventricles are fluid filled sinues that appear to enlarge as the surrounding tissue shrinks. This enlargement is associated with worse brain functions, future work need to determine how predictive this will be loss of brain function

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