Musician Billy Joel is seen throughout his one centesimal lifetime efficiency at Madison Sq. Backyard in 2018, in New York.
Evan Agostini/Invision/AP
disguise caption
toggle caption
Evan Agostini/Invision/AP
Billy Joel canceled the remainder of his summer time live shows and introduced that he has a mind situation known as regular strain hydrocephalus.
“I am sincerely sorry to disappoint our viewers, and thanks for understanding,” Joel, 76, advised followers in a put up to social media on Friday.
The situation has precipitated issues with Joel’s “listening to, imaginative and prescient and stability,” in accordance with the assertion, and his medical doctors suggested him towards performing as a result of it has exacerbated these signs. Joel is present process bodily remedy and says he hopes to return to the stage in the future.
The situation is treatable, however underdiagnosed, medical doctors inform NPR.
By going public along with his analysis, the musician might assist others, says Dr. Charles Matouk, vice chair of scientific affairs on the division of neurosurgery at Yale College of Drugs.
“Billy Joel is extremely courageous,” Matouk says. “Extra individuals are going to be alerted to this drawback and perhaps get the assistance they want sooner.”
Listed here are three issues to find out about regular strain hydrocephalus (NPH).
1. It occurs when cerebrospinal fluid builds up within the mind
In wholesome individuals, the physique makes about half a liter of cerebrospinal fluid a day, says Dr. Gayatri Devi, director of Park Avenue Neurology in Manhattan. The fluid has a number of features, together with cushioning the mind towards the onerous, bony cranium, transporting vitamins and eradicating waste.
Usually, the fluid will get reabsorbed by way of giant veins within the head, nevertheless it would not at all times occur that means in individuals who have regular strain hydrocephalus.
“What can generally occur is there are some slender bottleneck components of the system,” Devi says. “And generally in these areas, you’ll be able to have some construct up over time, as we grow old, of proteins and different substances and that causes the fluid to again up.”
This “sludge” that causes the buildup is not properly understood, nevertheless it is not a part of regular getting older, says Matouk of Yale.
“As a result of your cranium is a closed field, the water wants a means out or else strain’s going to construct up,” he says.
Regardless of elevated strain on the mind, it is known as regular strain hydrocephalus as a result of it occurs so slowly that it stays throughout the regular vary, in accordance with the Cleveland Clinic.
2. Signs are simple to overlook
The telltale indicators of regular strain hydrocephalus are issues with strolling, cognitive signs and urinary incontinence. However since sufferers who’ve it are often over 60, they’ll appear like regular indicators of getting older.
“All of us have grandmas and grandpas which have hassle strolling as a result of they’ve unhealthy hips and knees and their again hurts,” Matouk says. “Each women and men, as you grow old, are going to begin having hassle controlling their bladder. … You are going to have hassle together with your reminiscence.”
However when all three occur on the similar time and progressively worsen, that ought to be an indication that one thing is just not regular.
That mentioned, it would not at all times occur that means.
“What makes issues much more sophisticated is individuals do not must have all three,” Devi says. “They may simply have the urinary drawback. They may simply have the gait drawback. They may simply have the reminiscence drawback.”
What’s extra, generally the motion issues are misdiagnosed as Parkinson’s illness, and the cognitive issues are misdiagnosed as Alzheimer’s. (Although Matouk cautions that Alzheimer’s dementia is completely different from the sort of dementia that arises from untreated regular strain hydrocephalus over time.)
As soon as regular strain hydrocephalus is suspected, diagnosing it often entails a CT scan or a mind MRI. Medical doctors who spoke with NPR mentioned they have not had issue getting insurance coverage to pay for the testing.
Nevertheless, as a result of some radiologists do not know the right way to spot it, it may be onerous to get a analysis, says Dr. Ryan Lee, assistant professor of neurosurgery at Vanderbilt College Medical Heart. “It does take some persistence on the a part of the one who ordered the check or the household and the affected person” to ensure the pictures are evaluated by a specialist, he says.
The following check is often a lumbar puncture, or spinal faucet, by which medical doctors insert a needle into the spinal canal to gather some spinal fluid. Then they ask the affected person and their members of the family if any signs have modified. “We even have the bodily therapist consider earlier than and after,” Lee says, to keep away from any sort of placebo impact.
3. It is treatable
To alleviate strain on the mind, medical doctors carry out a surgical procedure that entails drilling a gap into the cranium and inserting a shunt into the mind to empty the surplus fluid to be absorbed by one other a part of the physique — often the stomach.
“As a result of the fluid is getting made constantly, you want one thing that constantly drains the fluid,” says Devi of Park Avenue Neurology.
Surgical procedure is not for everybody and carries dangers, like an infection, however sufferers can often go house the subsequent day, she says. The sooner regular strain hydrocephalus is caught and handled, the higher.
The surgical procedure is not a remedy, however “the response might be actually outstanding,” says Lee of Vanderbilt.
“Sufferers can go from being in a wheelchair and never in a position to stroll and never in a position to suppose very clearly or bear in mind a lot to having the ability to stroll nearly usually and having an enchancment of their cognition and high quality of life considerably,” he says.
Matouk cautioned that cognitive signs have a tendency to enhance much less dramatically than the opposite signs.
Nonetheless, Matouk, who’s learning a new, much less invasive process for these sufferers, hopes consciousness of this situation will assist sufferers advocate for themselves.
“There’s only a few issues in medication the place we will reverse signs or enhance signs, and it is a illness the place that is doable,” he says. “So, it is a disgrace if it is missed — and it usually is, for months or years, till the right analysis is arrived at.”
