What to find out about Billy Joel’s mind situation : NPR

Billy Joel canceled the remainder of his summer season concert events and introduced that he has a mind situation known as regular stress hydrocephalus.

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

The situation has triggered issues with Joel’s “listening to, imaginative and prescient and steadiness,” in line 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 sooner or later.

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

By going public together with his prognosis, the musician may assist others, says Dr. Charles Matouk, vice chair of scientific 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 downside and possibly get the assistance they want sooner.”

Listed below are three issues to find out about regular stress hydrocephalus (NPH).

1. It occurs when cerebrospinal fluid builds up within the mind

In wholesome folks, 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 towards the onerous, bony cranium, transporting vitamins and eradicating waste.

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

“What can generally occur is there are some slim bottleneck elements of the system,” Devi says. “And generally in these areas, you may have some construct up over time, as we become old, 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 ageing, says Matouk of Yale.

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

Regardless of elevated stress on the mind, it is known as regular stress hydrocephalus as a result of it occurs so slowly that it stays inside the regular vary, in line with the Cleveland Clinic.

2. Signs are simple to overlook

The telltale indicators of regular stress hydrocephalus are issues with strolling, cognitive signs and urinary incontinence. However since sufferers who’ve it are normally over 60, they will seem like regular indicators of ageing.

“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 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 just isn’t regular.

That stated, it would not at all times occur that method.

“What makes issues much more sophisticated is folks do not should have all three,” Devi says. “They might simply have the urinary downside. They might simply have the gait downside. They might simply have the reminiscence downside.”

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 type of dementia that arises from untreated regular stress hydrocephalus over time.)

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

Nevertheless, as a result of some radiologists do not know tips on how to spot it, it may be onerous to get a prognosis, 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 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 subsequent take a look at is normally a lumbar puncture, or spinal faucet, wherein 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 type of placebo impact.

3. It is treatable

To alleviate stress 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 repeatedly, you want one thing that repeatedly 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 house the following day, she says. The sooner regular stress hydrocephalus is caught and handled, the higher.

The surgical procedure is not a treatment, however “the response may be actually exceptional,” 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 bear in mind a lot to having the ability to stroll virtually 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 prognosis is arrived at.”