Plain language summary publication: Role of diffusion tensor imaging in the evaluation of white matter integrity in idiopathic intracranial hypertension

Main Finding: We used a special imaging technique to study patients with idiopathic intracranial hypertension (IIH), a condition that raises pressure inside the skull. Our findings suggest that these patients may have changes in the brain's white matter and in the optic nerve, which connects the eyes to the brain. Motivation (Problem): Idiopathic intracranial hypertension is a condition in which pressure inside the brain is higher than normal without an obvious cause. It often affects women of reproductive age who are obese, and as obesity becomes more common, more people are being diagnosed with IIH. Scientists still do not fully understand what causes this condition, but studying how the brain regulates pressure is key to finding answers. Methods: We used a type of imaging called diffusion tensor imaging to study the brain's white matter and the pathways connecting the eyes to the brain in patients with IIH and in healthy people for comparison. We wanted to see if increased pressure in the skull might affect these brain structures. We also recorded clinical and eye examination results for the patients with IIH. Then, we compared the imaging data between the two groups to see if there were any differences in specific parts of the brain and the optic pathways. Results: We found differences in several brain areas, including regions that control movement and coordination. There was a clear link between higher pressure inside the skull and changes in certain brain pathways. We also discovered that patients with thicker retinal nerve fiber layers (a part of the eye) had more changes in the optic nerve structure. This suggests that higher pressure in the brain may damage both the brain and the optic nerve. Implications: Our study shows that IIH may cause damage to the brain's white matter and optic nerve, likely due to the increased pressure inside the skull. We believe the pressure may cause swelling and damage to the nerve fibers, leading to these changes. This research helps us understand how IIH affects the brain and could lead to better treatments for managing the condition and preventing further damage. Bahar Atasoy: Conceptualization; data curation; investigation; methodology; writing – original draft. Asli Yaman Kula: Data curation; investigation; methodology. Serdar Balsak: Data curation; investigation; writing – original draft. Yagmur Basak Polat: Data curation; methodology. Zeynep Donmez: Investigation; methodology; writing – original draft. Ahmet Akcay: Data curation; methodology. Abdusselim Adil Peker: Data curation; formal analysis. Ozlem Toluk: Formal analysis. Alpay Alkan: Conceptualization; investigation; supervision; writing – review and editing. Bahar Atasoy, Asli Yaman Kula, Serdar Balsak, Yagmur Basak Polat, Zeynep Donmez, Ahmet Akcay, Abdusselim Adil Peker, Ozlem Toluk and Alpay Alkan declare no conflict of interest.