Objective: To investigate the prevalence of idiopathic normal pressure hydrocephalus (iNPH)-related imaging findings (DESH) and their clinical characteristics in Parkinson’s disease (PD) patients.

Background: PD and iNPH are common movement disorders in the elderly. Recent studies have reported a high prevalence of PD biomarkers in iNPH, but the frequency and clinical significance of iNPH-related imaging findings, particularly disproportionately enlarged subarachnoid space hydrocephalus (DESH), in PD patients remain unclear.

Method: We analyzed MRI findings of 188 consecutive PD inpatients at our hospital and classified them as DESH, Incomplete DESH, or Non-DESH based on the proposed DESH diagnostic criteria. DESH was defined by the presence of all three key features: Evans index >0.3, narrowing of the high convexity subarachnoid space, and enlargement of the Sylvian fissures. We examined the association between these imaging findings and clinical parameters.

Results: Among PD patients, 6 (3.2%) had complete DESH, 26 (13.8%) had Incomplete DESH, and 147 (78.2%) were classified as Non-DESH. Specifically, Evans index >0.3 was observed in 33 patients (17.6%), narrowing of the high convexity subarachnoid space in 20 patients (10.6%), and enlargement of the Sylvian fissures in 69 patients (36.7%). Compared to the Non-DESH group, the DESH group was older, had a later disease onset, and exhibited more severe balance impairment as assessed by the Mini-BESTest.

Conclusion: A subset of PD patients exhibit DESH findings, with Sylvian fissure enlargement being particularly common. These findings suggest potential interactions between PD pathology and iNPH-related changes, highlighting the need to consider iNPH comorbidity, especially in older PD patients with pronounced balance impairment. Further studies with multiple raters and validation in a multicenter setting are required to confirm our findings.

References: (1) Odagiri H, Baba T, Nishio Y, Iizuka O, Narita W, Matsuda M, et al. Clinical characteristics of idiopathic normal pressure hydrocephalus with Lewy body diseases. Journal of the Neurological Sciences. 2015;359(1-2):309-11.
(2) Sakurai A, Tsunemi T, Ishiguro Y, Okuzumi A, Hatano T, Hattori N. Comorbid alpha synucleinopathies in idiopathic normal pressure hydrocephalus. Journal of Neurology. 2022;269(4):2022-9.
(3) Narita W, Nishio Y, Baba T, Iizuka O, Ishihara T, Matsuda M, et al. High-Convexity Tightness Predicts the Shunt Response in Idiopathic Normal Pressure Hydrocephalus. American Journal of Neuroradiology. 2016;37(10):1831-7.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/prevalence-and-clinical-characteristics-of-inph-related-imaging-findings-desh-in-parkinsons-disease/