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Volume 12 Supplement 1

Abstracts from Hydrocephalus 2015

  • Poster presentation
  • Open Access

Disproportionately enlarged subarachnoid space hydrocephalus presence in patients with idiopathic normal pressure hydrocephalus

  • 1Email author,
  • 2,
  • 2 and
  • 1
Fluids and Barriers of the CNS201512 (Suppl 1) :P43

  • Published:


  • Hydrocephalus
  • Subarachnoid Space
  • Infusion Test
  • Single Predictor
  • Normal Pressure Hydrocephalus


Idiopathic normal pressure hydrocephalus (iNPH) is a treatable disease of an elderly people. It`s known for 50 years, but there are still some controversies, especially in the diagnostic algorithm. Disproportionately enlarged subarachnoid space hydrocephalus (DESH) seems to be important radiological feature of iNPH, but it`s not present in all patients. The aim of our study was to analyse appearance of DESH in our set of patients.


We retrospectively analysed 1, 5 T MRI in 27 iNPH patients before surgery and MRI in 24 healthy controls. Evaluation was performed by neurosurgeon and radiologist independently and blindly. We assessed tight high convexity and medial subarachnoid space, dilatation of Sylvian fissure and focal dilatation of sulci. iNPH patients were identified by clinical examination, dilatation of ventricles on MRI defined by Evans` ratio > 0, 30 and positive tap test and/or lumbar infusion test. Patient outcome was measured by iNPH grading scale one year after surgery.


In the group of 27 iNPH patients, we have found DESH presence in15 cases (55, 6%), all 15 patients were shunt responders. In the group of 12 iNPH patients without DESH 4 of them did not respond to surgery (33, 3%).

Among the 24 healthy controls, we haven`t found any DESH appearance.


We confirmed, that DESH appearance on MRI is supportive for the iNPH diagnosis, but it should not be used as a single predictor. Patients without DESH are at a higher risk to be shunt non-responders. Indication for shunt surgery should be still based on correlation between the radiological and clinical evaluation and supplementary CSF dynamics tests.

Supported by IGA NT14448-3/2013.

Authors’ Affiliations

Department of Neurosurgery, Masaryk Hospital, Usti nad Labem, Czech Republic
Department of Radiology, Masaryk Hospital, Usti nad Labem, Czech Republic


© Radovnicky et al. 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.