This patient exhibits classical clinical features of normal pressure hydrocephalus (NPH) with pronounced gait ataxia.

Disproportionately enlarged subarachnoid space hydrocephalus (DESH) is a feature of NPH. There is widespread sulcal enlargement particularly affecting the Sylvian fissures and insular cisterns but the gyri are tightly apposed at the high convexity and this distinguishes DESH from parenchymal atrophy.

NPH may respond to surgical shunting, and some studies suggest that DESH is an indicator of favorable outcome.