Musician Billy Joel is seen throughout his a hundredth lifetime efficiency at Madison Sq. Backyard in 2018, in New York.
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Evan Agostini/Invision/AP
Billy Joel canceled the remainder of his summer season live shows 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, instructed followers in a publish to social media on Friday.
The situation has induced issues with Joel’s “listening to, imaginative and prescient and steadiness,” in response to the assertion, and his docs 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 in the future.
The situation is treatable, however underdiagnosed, docs inform NPR.
By going public along with his analysis, the musician might assist others, says Dr. Charles Matouk, vice chair of medical 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 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 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 in opposition to the laborious, bony cranium, transporting vitamins and eradicating waste.
Usually, the fluid will get reabsorbed by massive veins within the head, however it does not all the time occur that approach in individuals who have regular stress hydrocephalus.
“What can typically occur is there are some slender bottleneck elements of the system,” Devi says. “And typically in these areas, you possibly can 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 nicely understood, however it 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 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 response to 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 often 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 old, are going to start out having hassle controlling their bladder. … You are going to have hassle together with your reminiscence.”
However when all three occur on the identical time and progressively worsen, that must be an indication that one thing isn’t regular.
That mentioned, it does not all the time occur that approach.
“What makes issues much more sophisticated is individuals do not should have all three,” Devi says. “They might simply have the urinary drawback. They might simply have the gait drawback. They might 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 stress hydrocephalus over time.)
As soon as regular stress hydrocephalus is suspected, diagnosing it often includes 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 find out how to spot it, it may be laborious 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 that ordered the take a look at or the household and the affected person” to verify the pictures are evaluated by a specialist, he says.
The following take a look at is often a lumbar puncture, or spinal faucet, wherein docs 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 stress on the mind, docs 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 — 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 residence 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 will 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 bear in mind a lot to with 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 this can be a illness the place that is potential,” 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.”
