Introduction: Brain atrophy is associated with physical disability in multiple sclerosis (MS), but there is a great variability between different studies and methodologies, and its use is still limited to research projects. We aimed to analyze the relationship between several volumetric measurements and physical disability and cognitive functioning in MS patients in a clinical practice setting. Methods: This is a cross-sectional study. A total of 41 patients (31 relapsing-remitting MS, 6 secondary-progressive MS, and 4 primary-progressive MS) were included. Whole brain volume (WBV), gray matter volume (GMV), and T2 lesion load (T2L) were obtained using Icometrix®,software. Physical disability was measured with the Expanded Disability Status Scale (EDSS), and cognitive status was evaluated with the brief repeatable battery of neuropsychological tests (BRB-N). The relationship between brain volumes and EDSS was analyzed through linear multivariate regression. The association between volumetry measurements and the number of affected cognitive domains was studied with negative binomial regression. Results: GMV was associated with age (b=-1. 7, P=0. 014) and with EDSS (b=-7. 55, P=0. 013). T2L was associated with EDSS (b=2. 29, P=0. 032). The number of affected cognitive domains was associated with clinical phenotype, worse in primary progressive MS (PPMS). There was not correlations between cognitive impairment and cerebral volumes. Conclusion: Brain atrophy measurement is feasible in clinical practice setting, and it is helpful in monitoring the EDSS progression. Primary progressive phenotype is associated with greater risk of cognitive dysfunction.

Background: Brain atrophy is a common finding in older people. However, in some cases, brain atrophy is not proportional to the patient’s age. Recently, there has been much focus on the neurotoxicity of anesthetic drugs.  Objectives: This study was planned to investigate whether exposure to anesthesia accelerates the process of brain atrophy. Materials & Methods: This case-control study was conducted in two academic hospitals affiliated with Guilan University of Medical Sciences (GUMS), Rasht City, Iran, from May 2024 to August 2024. Patients with early brain atrophy were included as the case group, and those who did not have early brain atrophy as the control group; 27 people in each group were studied. A checklist containing demographic data, history of receiving anesthesia, age of receiving anesthesia, and number of times receiving anesthesia was completed and the obtained data were compared between the two groups. Results: Regarding demographic data, no significant difference was observed between the two groups (P>0.05). Although early brain atrophy was more common in older people (62.59±8 vs 58±10.5 years), the difference was not significant (P=0.069). Two groups were also compared in terms of diabetes (P=0.054), hypertension (P=0.248), stroke (P=0.34), alcohol consumption and addiction (P=0.552). Regarding the history of receiving general anesthesia as the main variable of the study, the difference between the two groups was not significant (P=0.78). Conclusion: The results of this study did not show a significant association between receiving general anesthesia and early brain atrophy. However, given the remarkable limitations of this study and the valid evidence, well-planned future studies are welcome.

Prolonged use of topical corticosteroids, particularly in infants, albeit rare, may lead to Cushing syndrome. Central nervous system abnormalities including brain atrophy and delayed myelination on cranial magnetic resonance imaging has been reported in patients with corticosteroid treatment. We herein report a 5-month-old female infant referred to Department of Pediatric Endocrinology, Edirne, Turkey with brain atrophy and myelination delay that might be due to iatrogenic Cushing syndrome caused by topical corticosteroid use.

Cognitive impairment may be a common even at the onset of multiple sclerosis (MS). In this case-control study, we tried to find out the probable relationship between homocysteine levels and cerebral atrophy or cognitive impairment in patients with multiple sclerosis. One hundred fifty six patients who had MS according to McDonald diagnostic criteria were included in this study. Patients’ age, gender, and educational level, MS duration and clinical type, disability, cognitive function state based on minimental state examination (MMSE), presence of hyperhomocysteinemia, and brain atrophy were evaluated. There was no statistically significant relationship between hyperhomocysteinemia and cognitive status. Total homocysteine levels had a significant correlation with MMSE score only in those patients with elementary level of education. Also total homocysteine levels and overall cerebral atrophy did not indicate significant relationship according to those independent variables mentioned above except in the patients with EDSS less than 6. When intercaudate ratio>0.10 was applied as a criterion for cerebral atrophy, we found that hyperhomocysteinemia related significantly to intercaudate ratio>0.10 in females, aged between 21 and 30 years, MS duration £ 5 years, primary progressive MS and relapsing-remitting MS clinical types, EDSS £ 3 and elementary level of education. We suggest applying MMSE only for the first step of cognitive function survey. In the next steps, much more exact test must be used (e.g. MSNQ). Also we can not suggest measuring plasma homocysteine level as criterion for monitoring the cognitive function in patients with MS.