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

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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 known as regular strain 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 induced issues with Joel's "listening to, imaginative and prescient and steadiness," in response to 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 in the future.

The situation is treatable, however underdiagnosed, medical doctors 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 College of Medication.

"Billy Joel is extremely courageous," Matouk says. "Extra persons are going to be alerted to this drawback and possibly 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 features, together with cushioning the mind towards the onerous, bony cranium, transporting vitamins and eradicating waste.

Usually, the fluid will get reabsorbed by means of giant veins within the head, but it surely does not all the time occur that manner in individuals who have regular strain hydrocephalus.

"What can generally occur is there are some slim bottleneck elements of the system," Devi says. "And generally in these areas, you possibly can 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 getting old, says Matouk of Yale.

"As a result of your cranium is a closed field, the water wants a manner out or else strain's going to construct up," he says.

Regardless of elevated strain on the mind, it is known 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 getting old.

"All of us have grandmas and grandpas which have bother 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 start out having bother controlling their bladder. … You are going to have bother along with your reminiscence."

However when all three occur on the similar time and progressively worsen, that must be an indication that one thing just isn't regular.

That stated, it does not all the time occur that manner.

"What makes issues much more sophisticated is individuals do not need to 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, 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 totally 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 entails 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 the way 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 ensure the pictures are evaluated by a specialist, he says.

The following take a look at is normally a lumbar puncture, or spinal faucet, during 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 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 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 strain hydrocephalus is caught and handled, the higher.

The surgical procedure is not a remedy, however "the response might be actually exceptional," 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 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 brand 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 are able to 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."