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Background: The role of transcranial brain parenchyma sonography (TCS) is evolving. While hyperechogenicity of the substantia nigra as a marker of idiopathic Parkinson’s disease can be considered established, other parenchymal TCS findings need further evaluation. Among these, the width of the third ventricle might be relevant for patients with multiple sclerosis (MS). To explore its value, we performed an observational study of a cohort of mildly diseased MS patients over a period of 3 years with TCS examinations at study entry. Methods and findings: A total of 45 patients with relapsing-remitting MS [males, 12; females 33; at entry: mean age, 41 ± 10 years; mean disease duration, 6.7 ± 6.0 years; mean Expanded Disability Rating Scale (EDSS), 2.0 ± 1.32] under disease modifying therapy underwent at study entry an assessment of the 3rd ventricle width by means of TCS. Thereafter, regular clinical follow up was performed over 3 years. Normal 3rd ventricular width (mean 3.4 ± 0.80 mm) was generated from healthy volunteers (n=70, mean age 41 ± 15 years) at study entry. The mean ventricular width plus 1 SD of the controls was used for dichotomizing ventricular width. After 3 years, compared with patients with a ventricular width ≤4.2 mm, patients with a ventricular width >4.2 mm had suffered significantly more relapses [9/18 vs 5/27; odds ratio 4.4 (95% CI: 1.15–16.80); p<0.05]. Conclusion: In this cohort of mildly diseased MS patients, 3rd ventricular enlargement assessed by TCS was associated with relapse occurrence within 3 years.

Width of The Third Ventricle as Assessed by Transcranial Sonography is Associated with Future Relapses in Mild Multiple Sclerosis