Objective:

To explore a noninvasive diagnostic approach for idiopathic intracranial hypertension (IIH) using DTI-ALPS, specifically focusing on its potential as a diagnostic biomarker, and to advance understanding and treatment of IIH.

Key Findings:

• ALPS-indices in IIH patients were abnormal, clustering in ranges that are considered subnormal and supranormal compared to healthy controls, indicating significant deviations.
• A correlation was found between disease duration and ALPS-index, with chronic patients showing higher indices, suggesting a potential adaptive response.
• The study suggests that glymphatic dysfunction may be a consequence of IIH rather than its cause, highlighting the need for targeted therapeutic strategies.

Interpretation:

The findings indicate that while glymphatic dysfunction is present in IIH, it may not be the primary target for treatment, and ALPS-indices could serve as a potential diagnostic biomarker, warranting further investigation.

Limitations:

• The study is cross-sectional and does not track changes in ALPS-indices over time, limiting the understanding of disease progression.
• Sample sizes are currently small, limiting the generalizability of the findings, and longitudinal studies are needed to assess changes over time.

Conclusion:

Further research is needed to validate ALPS-indices as a reliable biomarker for IIH diagnosis and to understand their potential role in the disease's pathophysiology, including exploring therapeutic implications.