ALB and Brain atrophy: Abnormally high albumin levels in CSF are associated with intrathecal markers for CNS injury, increased numbers of circulating proinflammatory T helper cells, and a distinct CSF lipidomic profile.42 Increased CSF albumin has also been associated with the development of brain atrophy, greater risk for disease-associated disability, and presence of spinal MS lesions.43, –45 Our work shows a higher probability of BCSFB dysfunction and correspondingly higher albumin levels in the CSF in patients with a negative MRZR.