Musician Billy Joel is seen throughout his one centesimal 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 concert events and introduced that he has a mind situation referred to as regular stress hydrocephalus.
“I am sincerely sorry to disappoint our viewers, and thanks for understanding,” Joel, 76, instructed followers in a submit to social media on Friday.
The situation has brought about issues with Joel’s “listening to, imaginative and prescient and steadiness,” in line with 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 sooner or later.
The situation is treatable, however underdiagnosed, docs inform NPR.
By going public along with his prognosis, 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 individuals are going to be alerted to this drawback and perhaps 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 in opposition to the exhausting, bony cranium, transporting vitamins and eradicating waste.
Usually, the fluid will get reabsorbed by means of massive veins within the head, however it would not at all times occur that approach in individuals who have regular stress hydrocephalus.
“What can typically occur is there are some slim bottleneck components of the system,” Devi says. “And typically 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 nicely understood, however 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 approach out or else stress’s going to construct up,” he says.
Regardless of elevated stress on the mind, it is referred to as regular stress hydrocephalus as a result of it occurs so slowly that it stays throughout 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’ll appear to be 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 identical time and progressively worsen, that must be an indication that one thing isn’t regular.
That stated, it would not at all times occur that approach.
“What makes issues much more difficult is folks 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, 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 totally 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 entails a CT scan or a mind MRI. Docs 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 easy methods to spot it, it may be exhausting 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 who 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, by which docs 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, docs 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 — 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 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 may be actually outstanding,” says Lee of Vanderbilt.
“Sufferers can go from being in a wheelchair and never capable of stroll and never capable of assume very clearly or keep in mind a lot to with 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 finding out 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 drugs 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 right prognosis is arrived at.”
