The musician Billy Joel is seen during his 100th performance for life at Madison Square Garden in 2018, in New York.
Evan Agostini / Invivision / AP
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Evan Agostini / Invivision / AP
Billy Joel canceled the rest of his summer concerts and announced that he had a cerebral condition called normal pressure hydrocephalus.
“I am sincerely sorry to disappoint our audience, and thank you for your understanding,” said Joel, 76, to fans in a post to social media Friday.
The condition caused problems with “the hearing, vision and balance” of Joel, according to the press release, and his doctors advised him to play because he exacerbated these symptoms. Joel is in physical therapy and says he hopes to go back to stage one day.
The condition is treatable, but underdiagnosed, say to doctors NPR.
By making public his diagnosis, the musician could help others, explains Dr. Charles Matouk, vice-president of clinical affairs of the Yale School of Medicine neurosurgery.
“Billy Joel is incredibly courageous,” says Matouk. “More people will be alerted from this problem and maybe get the help they need earlier.”
Here are three things to know about normal pressure hydrocephalus (NPH).
1. This happens when the cerebrospinal fluid accumulates in the brain
In healthy people, the body is about half a liter of cerebrospinal fluid per day, says Dr Gayatri Devi, director of Park Avenue Neurology in Manhattan. The liquid has several functions, including cushioning the brain against the hard and bone skull, the transport of nutrients and the elimination of waste.
Normally, the liquid is reabsorbed through large veins in the head, but this does not always happen in this way in people who have normal pressure hydrocephalus.
“What can sometimes happen is that there are narrow strangulation parts of the system,” said Devi. “And sometimes in these areas, you can have an accumulation over time, as we age, proteins and other substances and this causes the liquid safeguard.”
This “mud” which causes accumulation is not well understood, but it is not part of normal aging, explains Matouk de Yale.
“Because your skull is a closed box, the water needs an outcome or if the pressure will accumulate,” he said.
Despite increased pressure on the brain, this is called normal pressure of hydrocephalus because it occurs so slowly that it remains in the normal beach, according to Cleveland Clinic.
2. Symptoms are easy to miss
The indicative signs of normal pressure hydrocephalus are problems of walking, cognitive symptoms and urinary incontinence. But as patients who are generally over 60 years old, they can look like normal aging signs.
“We all have grandmothers and grandfather who find it difficult to walk because they have bad hips and knees and their back hurts,” said Matouk. “Men and women, as they get older, will start to have trouble controlling their bladder. … You will have problems with your memory.”
But when all three occur at the same time and is gradually worsening, it should be a sign that something is not normal.
That said, it doesn’t always happen this way.
“What makes things even more complicated is that people don’t have to have the three,” said Devi. “They could simply have the urinary problem. They could simply have the problem of the process. They could simply have the problem of memory.”
In addition, sometimes movement problems are poorly diagnosed as Parkinson’s disease, and cognitive problems are poorly diagnosed as a Alzheimer. (Although Matouk warns that Alzheimer’s dementia is different from the type of dementia that comes from normal pressure hydrolephalus not treated over time.)
Once the normal pressure hydrocephalus is suspected, the diagnosis generally involves a scanner or a brain MRI. The doctors who spoke with NPR said that they had no difficulty in paying the insurance for the tests.
However, as some radiologists do not know how to spot it, it may be difficult to obtain a diagnosis, explains Dr. Ryan Lee, assistant professor of neurosurgery at the Vanderbilt University Medical Center. “It takes a certain persistence on the part of the person who ordered the test or the family and the patient” to ensure that the images are evaluated by a specialist, he said.
The following test is generally a lumbar puncture, or a vertebral tap, in which doctors inserts a needle in the vertebral channel to collect a little vertebral liquid. Then they ask the patient and their family members if symptoms have changed. “We also have the evaluation of the physiotherapist before and after,” explains Lee, to avoid any type of placebo effect.
3. It’s treatable
To relieve the pressure on the brain, doctors perform surgery that involves drilling a hole in the skull and inserting a shunt into the brain to drain the excess liquid to be absorbed by another part of the body – usually the abdomen.
“Because the liquid is done continuously, you need something that continuously drains the liquid,” said Devi of Park Avenue Neurology.
Surgery is not for everyone and has risks, such as infection, but patients can usually go home the next day, she said. Hydrocephalus of anterior normal pressure is captured and treated, the better.
Surgery is not a remedy, but “the answer can be really remarkable,” said Lee de Vanderbilt.
“Patients can go from a wheelchair and not be able to walk and not be able to think very clearly or to remember much of being able to walk almost normally and to have an improvement in their cognition and their quality of life considerably,” he said.
Matouk warned that cognitive symptoms tend to improve less considerably than other symptoms.
Yet Matouk, who studies a New and less invasive procedure For these patients, the hope of raising awareness of this condition will help patients defend themselves.
“There is very little in medicine where we can reverse the symptoms or improve symptoms, and it is a disease where this is possible,” he said. “So, it’s a shame if we are missing – and it is often, for months or years, until the right diagnosis has arrived.”