What to learn about Billy Joel’s mind situation : NPR

Billy Joel canceled the remainder of his summer season live shows and introduced that he has a mind situation referred to as regular strain hydrocephalus.

“I am sincerely sorry to disappoint our viewers, and thanks for understanding,” Joel, 76, informed followers in a publish to social media on Friday.

The situation has triggered issues with Joel’s “listening to, imaginative and prescient and stability,” in response to the assertion, and his medical doctors suggested him in opposition to 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 at some point.

The situation is treatable, however underdiagnosed, medical doctors inform NPR.

By going public together with his analysis, the musician might assist others, says Dr. Charles Matouk, vice chair of medical affairs on the division of neurosurgery at Yale Faculty of Medication.

“Billy Joel is extremely courageous,” Matouk says. “Extra persons are going to be alerted to this drawback and perhaps get the assistance they want sooner.”

Listed here are three issues to learn 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 capabilities, together with cushioning the mind in opposition to the laborious, bony cranium, transporting vitamins and eradicating waste.

Usually, the fluid will get reabsorbed by giant veins within the head, but it surely would not at all times occur that approach in individuals who have regular strain hydrocephalus.

“What can typically occur is there are some slender bottleneck elements of the system,” Devi says. “And typically in these areas, you’ll be able to have some construct up over time, as we become older, of proteins and different substances and that causes the fluid to again up.”

This “sludge” that causes the buildup is not effectively understood, but it surely is not a part of regular growing older, says Matouk of Yale.

“As a result of your cranium is a closed field, the water wants a approach out or else strain’s going to construct up,” he says.

Regardless of elevated strain on the mind, it is referred to as regular strain hydrocephalus as a result of it occurs so slowly that it stays throughout the regular vary, in response to 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 normally over 60, they’ll appear to be regular indicators of growing 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 become older, 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 needs to be an indication that one thing just isn’t regular.

That mentioned, it would not at all times occur that approach.

“What makes issues much more difficult is individuals do not should 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, typically 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 form of dementia that arises from untreated regular strain hydrocephalus over time.)

As soon as regular strain hydrocephalus is suspected, diagnosing it normally includes a CT scan or a mind MRI. Medical doctors who spoke with NPR mentioned they have not had problem getting insurance coverage to pay for the testing.

Nevertheless, as a result of some radiologists do not know spot it, it may be laborious to get a analysis, says Dr. Ryan Lee, assistant professor of neurosurgery at Vanderbilt College Medical Middle. “It does take some persistence on the a part of the one that ordered the take a look at or the household and the affected person” to verify the photographs are evaluated by a specialist, he says.

The following take a look at is normally a lumbar puncture, or spinal faucet, through which medical doctors insert a needle into the spinal canal to gather some spinal fluid. Then they ask the affected person and their relations if any signs have modified. “We even have the bodily therapist consider earlier than and after,” Lee says, to keep away from any form of placebo impact.

3. It is treatable

To alleviate strain on the mind, medical doctors carry out a surgical procedure that includes 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 — normally 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 normally go dwelling the following day, she says. The sooner regular strain hydrocephalus is caught and handled, the higher.

The surgical procedure is not a remedy, however “the response could 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 assume very clearly or keep 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 attainable,” he says. “So, it is a disgrace if it is missed — and it typically is, for months or years, till the proper analysis is arrived at.”