Our Take: Beacon neurosurgeon shares insights about Billy Joel’s brain condition
Dr. Osmond Wu, neurosurgeon, Beacon Medical Group North Central Neurosurgery
The legendary Billy Joel late last week announced the cancelation of his remaining scheduled concerts due to his recent diagnosis of normal pressure hydrocephalus. We asked Dr. Osmond Wu, neurosurgeon, Beacon Medical Group North Central Neurosurgery, to shed light on the brain condition, how it is diagnosed and treatment options.
What is normal pressure hydrocephalus? Normal pressure hydrocephalus is a condition where cerebrospinal fluid builds up in the brain, leading to unsteady, slow gait, memory and cognitive decline, and possible urinary incontinence or urgency.
How does it affect the person diagnosed with the condition? It significantly impacts daily life through problems in walking or gait, memory decline and urinary problems. These symptoms typically develop gradually and can severely limit a person’s independence.
How common or uncommon is this condition? It is relatively uncommon, affecting roughly 1-2% of people over 65, though we suspect it’s underdiagnosed because symptoms are often mistaken for normal aging or conditions like dementia. The prevalence increases with age, making it more common in patients in their 70s and 80s.
Who is most at risk of being diagnosed? Older patients, particularly those over 60, are at highest risk for developing normal pressure hydrocephalus. Additional risk factors include previous head trauma or brain infections like meningitis, although many cases occur without any clear precipitating cause.
What are symptoms? Can they look like another diagnosis? The main symptoms are an unsteady, shuffling gait, memory and cognitive decline, and urinary incontinence or urgency. Normal pressure hydrocephalus can be very difficult to diagnose because these symptoms often mimic Alzheimer’s disease, Parkinson’s, or other forms of dementia. The key difference is that gait problems typically appear early and prominently in normal pressure hydroceophalus while memory loss usually dominates in Alzheimer’s.
When should you see a doctor? You should consult your physician as soon as you develop any combination of walking difficulties, memory problems, or urinary symptoms — especially if they occur together or progress relatively quickly. Early evaluation is important.
What will a doctor do during evaluation? We typically order CT or MRI scans, then often perform a high-volume lumbar puncture where we remove cerebrospinal fluid and carefully assess gait and cognitive function before and after the procedure. This helps determine if reducing fluid pressure temporarily improves symptoms.
What is treatment? Is a shunt always necessary? A shunt, which drains excess fluid from the brain to the abdomen, is the main treatment option. However, a shunt isn’t automatically recommended for everyone – the decision depends on how well patients respond to the diagnostic spinal tap, their overall health, and other clinical factors.
What is long-term outlook? The outlook varies significantly from patient to patient. Some people experience dramatic improvements in walking, thinking, and urinary control after shunt placement, while others see more modest benefits or may need additional procedures. Generally, patients treated earlier in their disease course and those who respond well to the initial spinal tap tend to have better outcomes.
Learn more about Beacon neurosurgery
Beacon Medical Group North Central Neurosurgery is a team of multidisciplinary neurosurgeons and medical professionals whose sole focus is the relief of your pain and discomfort through the use of the latest state-of-the-art operative and nonoperative treatments. Our team’s primary goal is to care for the entire central nervous system, including treatment for the brain, neck, spine and peripheral nerves.
