Skip to main content

Volume 12 Supplement 1

Abstracts from Hydrocephalus 2015

  • Oral presentation
  • Open access
  • Published:

DESH negative normal pressure hydrocephalus: can patients still benefit from shunt insertion?


Selecting probable idiopathic normal pressure hydrocephalus (INPH) patients for shunt insertion presents a challenge because of coexisting comorbidities and other conditions that could mimic NPH. The characteristic appearance of DESH (Disproportionately Enlarged Subarachnoid Space Hydrocephalus) on brain imaging has been shown to have a high positive predictive value in identifying shunt responsive INPH patients (SINPHONI trial). However, the negative predictive value of this radiological sign was not clearly demonstrated.


A single centre retrospective study of probable INPH patients, who underwent ventriculoperitoneal shunt insertion. Case notes were reviewed for clinical presentation, prognostic tests used and postoperative improvement. Shunt responsive INPH patients were identified as those having objective improvement in their walking speed, neuropsychological assessment as well as subjective improvements in gait, continence and memory, one year post operatively. Preoperative images were reviewed for DESH sign (2 independent reviewers). Negative and Positive Predictive Values (NPV and PPV) of DESH sign were determined post analysis.


A total of 103 probable INPH patients were included (31 were DESH positive (30%) and 72 were DESH negative (70%)). A total of 78 patients showed measurable improvement 1 year post shunt insertion (76%); 24 (31%) of these patients were DESH positive and 54 (69%) were DESH negative (P = <0.001). Therefore, the DESH sign had a PPV of 77% and a NPV of 25%.


In our data, the presence of DESH sign demonstrates a high positive predictive value of 77%, in agreement with SINPHONI trial data. However, it has shown a low negative predictive value. We conclude that probable NPH patients should not be excluded from having shunt insertion based on the presence of DESH sign alone.



Disproportionately Enlarged Subarachnoid Space Hydrocephalus


Normal Pressure Hydrocephalus.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Claudia Craven.

Rights and permissions

Open Access  This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made.

The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.

To view a copy of this licence, visit

The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mostafa, T., Craven, C., Patel, N.A. et al. DESH negative normal pressure hydrocephalus: can patients still benefit from shunt insertion?. Fluids Barriers CNS 12 (Suppl 1), O52 (2015).

Download citation

  • Published:

  • DOI: