Diagnosis & Imaging
DESH sign (disproportionately enlarged subarachnoid space hydrocephalus)
The DESH sign is an imaging pattern associated with normal pressure hydrocephalus, showing tight and widened CSF spaces in characteristic locations.
In short: DESH sign (disproportionately enlarged subarachnoid space hydrocephalus)
- It is an imaging pattern seen in some normal pressure hydrocephalus.
- It shows crowded spaces at the top of the brain and widened spaces elsewhere.
- It can support the diagnosis of NPH.
- It is interpreted alongside symptoms and other findings.
What it is
The DESH sign (disproportionately enlarged subarachnoid space hydrocephalus) is an imaging pattern associated with normal pressure hydrocephalus (NPH). It shows a characteristic combination: tight, crowded CSF spaces at the top of the brain and widened CSF spaces in other locations (such as the Sylvian fissures), along with enlarged ventricles.
Understanding DESH sign (disproportionately enlarged subarachnoid space hydrocephalus)
In NPH, the distribution of CSF spaces can take on this disproportionate pattern — narrow at the high convexity (top of the brain) and widened elsewhere — which differs from the more uniform changes seen with brain atrophy. When present, the DESH sign can support the diagnosis of NPH and suggest a person may respond to shunting, though it is not present in every case and is interpreted alongside symptoms, the response to tests like a tap test, and other findings. Recognizing DESH on imaging is one of several features that contribute to identifying NPH and selecting patients for treatment.
Why it matters
Understanding the DESH sign helps families interpret imaging reports in the context of NPH, and see how this characteristic pattern can support the diagnosis and inform treatment decisions, alongside other findings.
Common questions
What is the DESH sign?
An imaging pattern with crowded spaces at the top of the brain and widened spaces elsewhere, seen in some NPH.
What does it support?
The diagnosis of NPH and potential shunt response.
Is it present in every case?
No — it is interpreted alongside symptoms and other findings.
Bottom line
The DESH sign is an imaging pattern associated with normal pressure hydrocephalus that can support the diagnosis, interpreted alongside other findings.
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