Billy Joel cancels tour dates after diagnosis. What to know about the brain condition

Musician Billy Joel is seen during his 100th life capacity astatine Madison Square Garden successful 2018, successful New York. Evan Agostini/Invision/AP hide caption

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Evan Agostini/Invision/AP

Billy Joel canceled nan remainder of his summertime concerts and announced that he has a encephalon information called normal unit hydrocephalus.

"I'm sincerely sorry to disappoint our audience, and convey you for understanding," Joel, 76, told fans successful a station to societal media connected Friday.

The information has caused problems pinch Joel's "hearing, imagination and balance," according to nan statement, and his doctors advised him against performing because it has exacerbated those symptoms. Joel is undergoing beingness therapy and says he hopes to return to nan shape 1 day.

The information is treatable, but underdiagnosed, doctors show NPR.

By going nationalist pinch his diagnosis, nan musician could thief others, says Dr. Charles Matouk, vice chair of objective affairs astatine nan section of neurosurgery astatine Yale School of Medicine.

"Billy Joel is incredibly brave," Matouk says. "More group are going to beryllium alerted to this problem and possibly get nan thief they request sooner."

Here are 3 things to cognize astir normal unit hydrocephalus (NPH).

1. It happens erstwhile cerebrospinal fluid builds up successful nan brain

In patient people, nan assemblage makes astir half a liter of cerebrospinal fluid a day, says Dr. Gayatri Devi, head of Park Avenue Neurology successful Manhattan. The fluid has respective functions, including cushioning nan encephalon against nan hard, bony skull, transporting nutrients and removing waste.

Normally, nan fluid gets reabsorbed done ample veins successful nan head, but it doesn't ever hap that measurement successful group who person normal unit hydrocephalus.

"What tin sometimes hap is location are immoderate constrictive bottleneck parts of nan system," Devi says. "And sometimes successful those areas, you tin person immoderate build up complete time, arsenic we get older, of proteins and different substances and that causes nan fluid to backmost up."

This "sludge" that causes nan buildup isn't good understood, but it isn't portion of normal aging, says Matouk of Yale.

"Because your skull is simply a closed box, nan h2o needs a measurement retired aliases other pressure's going to build up," he says.

Despite accrued unit connected nan brain, it's called normal unit hydrocephalus because it happens truthful slow that it stays wrong nan normal range, according to the Cleveland Clinic.

2. Symptoms are easy to miss

The telltale signs of normal unit hydrocephalus are problems pinch walking, cognitive symptoms and urinary incontinence. But since patients who person it are usually complete 60, they tin look for illustration normal signs of aging.

"We each person grandmas and grandpas that person problem stepping because they person bad hips and knees and their backmost hurts," Matouk says. "Both men and women, arsenic you get older, are going to commencement having problem controlling their bladder. … You're going to person problem pinch your memory."

But erstwhile each 3 hap astatine nan aforesaid clip and progressively get worse, that should beryllium a motion that thing is not normal.

That said, it doesn't ever hap that way.

"What makes things moreover much analyzable is group don't person to person each three," Devi says. "They could conscionable person nan urinary problem. They could conscionable person nan gait problem. They could conscionable person nan representation problem."

What's more, sometimes nan activity problems are misdiagnosed arsenic Parkinson's disease, and nan cognitive problems are misdiagnosed arsenic Alzheimer's. (Though Matouk cautions that Alzheimer's dementia is different from nan benignant of dementia that arises from untreated normal unit hydrocephalus complete time.)

Once normal unit hydrocephalus is suspected, diagnosing it usually involves a CT scan aliases a encephalon MRI. Doctors who said pinch NPR said they haven't had trouble getting security to salary for nan testing.

However, because immoderate radiologists don't cognize really to spot it, it tin beryllium difficult to get a diagnosis, says Dr. Ryan Lee, adjunct professor of neurosurgery astatine Vanderbilt University Medical Center. "It does return immoderate persistence connected nan portion of nan personification who ordered nan trial aliases nan family and nan patient" to make judge nan images are evaluated by a specialist, he says.

The adjacent trial is usually a lumbar puncture, aliases spinal tap, successful which doctors insert a needle into nan spinal canal to cod immoderate spinal fluid. Then they inquire nan diligent and their family members if immoderate symptoms person changed. "We besides person nan beingness therapist measure earlier and after," Lee says, to debar immoderate benignant of placebo effect.

3. It's treatable

To relieve unit connected nan brain, doctors execute a room that involves drilling a spread into nan skull and inserting a shunt into nan encephalon to drain nan excess fluid to beryllium absorbed by different portion of nan assemblage — usually nan abdomen.

"Because nan fluid is getting made continuously, you request thing that continuously drains nan fluid," says Devi of Park Avenue Neurology.

Surgery isn't for everyone and carries risks, for illustration infection, but patients tin usually spell location nan adjacent day, she says. The earlier normal unit hydrocephalus is caught and treated, nan better.

The room isn't a cure, but "the consequence tin beryllium really remarkable," says Lee of Vanderbilt.

"Patients tin spell from being successful a wheelchair and not capable to locomotion and not capable to deliberation very intelligibly aliases retrieve overmuch to being capable to locomotion almost usually and having an betterment successful their cognition and value of life significantly," he says.

Matouk cautioned that cognitive symptoms thin to amended little dramatically than nan different symptoms.

Still, Matouk, who is studying a new, little invasive procedure for these patients, hopes consciousness of this information will thief patients advocator for themselves.

"There's very fewer things successful medicine wherever we tin reverse symptoms aliases amended symptoms, and this is simply a illness wherever that's possible," he says. "So, it's a shame if it's missed — and it often is, for months aliases years, until nan correct test is arrived at."