DESH is considered a core feature of normal pressure hydrocephalus and can be mistakenly dismissed as a case of age-related cortical atrophy.

An important feature of DESH is the superior crowding of the brain parenchyma and, as the name implies, disproportionately widened inferior CSF spaces. This pattern predicts a poor treatment response.

Newer studies link DESH to abnormalities in the glymphatic system (which clears metabolites and soluble proteins) and abnormal cerebral glucose metabolism.