Disproportionately enlarged subarachnoid space hydrocephalus (DESH)

Last revised by Ahmad Alomari on 30 Jan 2024

Disproportionately enlarged subarachnoid space hydrocephalus (DESH) is a pattern of communicating hydrocephalus characterized by crowding of the sulci superiorly near the vertex accompanied by enlargement of CSF spaces more inferiorly, particularly in the Sylvian fissures 1. It is a prominent feature of idiopathic normal pressure hydrocephalus (iNPH) and is a central component of the Japanese iNPH diagnostic guidelines 2

Multiple, but not all, studies have found that the presence of DESH is predictive of shunt-response in patients with iNPH 1,3

The finding of DESH without neurologic symptoms has been termed asymptomatic ventriculomegaly with features of idiopathic normal pressure hydrocephalus on MRI (AVIM) 4. It is felt by some authors that AVIM is actually a pre-clinical form of iNPH 5

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Cases and figures

  • Case 1
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  • Case 2
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