Billy Joel’s Brain Condition, Explained
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Now that sounds like a good summer. Order now on Uber Eats. Terms apply. Product availability varies by region. See app for details. Welcome to Paging Dr. Gupta. You know, I always really look forward to this time of the week. It's a chance for me to connect with you. I get to hear what's on your mind. And I get to hopefully make some sense of the health questions you've been asking. But thank you so much for sending in all your questions. It really means a lot and I really do love hearing from you.

Many of you apparently have been following the news because you saw that music legend Billy Joel recently canceled part of his tour after being diagnosed with a condition called normal pressure hydrocephalus, or NPH. Now, hydrocephalus is a condition people often associate with infants, with babies. You might have heard it described as water on the brain. But the thing about hydrocephalus, it can also occur in adults, typically people over the age of 65.

So I'll tell you, you know, Billy Joel, first of all, I love Billy Joel. One of the first concerts I ever attended. I'm a huge fan. When I heard about his diagnosis, especially as a neurosurgeon, it really got my attention. And judging from all the questions you've been sending in, seems like it got your attention as well. So today we're taking a closer look at NPH, normal pressure hydrocephalus. Kira's back with us. Kira, who are we hearing from?

Hey Sanjay, so today we're starting off with a question from Robert in Wells, Maine, and he wants to know what causes hydrocephalus. All right, Kara, thank you. And Robert, thank you for that question. Couple things first, couple basics. Cerebral spinal fluid.

fluid that is circulating around the cerebrum, the brain, and the spine. So imagine your brain and your spinal cord, and you've got this fluid that is constantly bathing it. That's the cerebral spinal fluid, and we are continuously making this cerebral spinal fluid, or CSF. It bathes the brain and the spinal cord, and then it gets reabsorbed into the bloodstream. Hydrocephalus is basically an abnormal buildup of that fluid.

So there's these normal fluid-filled spaces in the brain called ventricles. When you get a CT scan or some sort of brain imaging, you see what normal ventricle size looks like, and then you see hydrocephalus, where those normal ventricles look plump, look swollen, look filled with fluid.

The type that Billy Joel has is called normal pressure hydrocephalus, and that's in large part because the fluid has built up slowly over time. And as a result, the fluid pressure inside the head is normal, or close to normal. It's not elevated. Why does it happen? Well, sometimes we just don't know. Sometimes it's because the surrounding brain shrinks a bit, and this fluid is sort of filling in that space. Sometimes it's because there is old head trauma, infection, tumors, perhaps a complication from surgery.

But again, a lot of times we don't know. We do know that it can cause specific symptoms. In fact, classic, what we call triad of symptoms, three symptoms, which are difficulty with walking, difficulty with cognition, and difficulty with bladder control. And these are some of the symptoms that Billy Joel has.

So he has this condition, normal pressure hydrocephalus. He has some of the associated symptoms. And I'm sure right now they're probably having conversations with their doctors about what to do, how to best treat this. Now, one thing I will tell you is that normal pressure hydrocephalus

It is not a common condition, but it's a mimic of other conditions. Someone comes into the office with cognition problems. A lot of times you may think, well, this is dementia. You get a brain scan, and you find, in fact, that the patient has normal pressure hydrocephalus, potentially treatable. Sometimes patients come in with questionable Parkinson's disease.

They get a brain scan and they're found to have normal pressure hydrocephalus, potentially treatable. You can see the pattern here. So again, not common, but potentially a treatable condition that mimics other existing conditions. Now coming up, one of you asked about something that your mom is going through, a spinal tap for normal pressure hydrocephalus. Could it actually help? What else could possibly help? We're going to talk it through right after the break.

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Okay, pagers going off again. Means we got another question. Kira. This next one is from Patty in Florida. She wrote in asking, Recently, my mom, who's 82, has been diagnosed with NPH. Next week, she's having a spinal tap. Can you tell me if it will make things better? All right, Patty, the spinal tap, the lumbar puncture, as it is sometimes called, what you're talking about is part of a diagnostic workup that's

that we do. Diagnostic mean it's intended to diagnose, not necessarily treat. But sometimes diagnostic tests can offer temporary treatment as well. Let me explain it like this. Imagine that fluid again circulating around the brain and the spinal cord. There's too much of it because it's not being reabsorbed into the bloodstream quickly enough. If you put a needle into the lower back and drain some of that fluid,

Sometimes patients will improve and improve quickly. Their balance improves, their bladder control improves, their cognition improves. So if that happens, if patients improve with the lumbar puncture and drainage of that fluid, that's a pretty good indication that a more permanent drainage of that fluid might be beneficial. Again, let me explain that. The lumbar puncture is really a diagnostic test. It is not a permanent solution. But it does two things at the same time.

sort of makes the diagnosis or confirms the diagnosis of normal pressure hydrocephalus, and the patients often get better, but only for a short time. So if that does work, a patient does get better, it's an indication that a more permanent procedure could be of benefit. Patty, I hope that gives you a clearer picture. Best wishes to your mom. Kira, what's our last question?

All right, last up, we actually have another question about a mom, and it's coming from Laura in Georgia, who wants to know, what are the chances that my mother can get some or all of her mobility back with the brain shunt procedure? Okay, so this is perfect. This follows on what we were just talking about. Laura, if that spinal tap I was talking about works...

That means a shunt can then be placed in the brain to drain the fluid off more permanently. Okay, so how does that work? It involves putting a catheter directly into one of those fluid-filled spaces in the brain. You do this through a small opening on the top of the brain, and then you connect that catheter to another catheter and a valve, which then drains the fluid typically into your abdominal cavity.

So now you have this closed-loop system where fluid is draining from that area on top of the brain, the ventricle, into the abdominal cavity. It takes some of that fluid away because the body is not absorbing it quickly enough. I hope that makes sense. How well does it work? Well, there's all sorts of studies here, but the good news is that it can be very effective. One study showed it could be up to 90% effective. A lot of studies have shown at least 60 to 70% effective.

meaning patients improve in terms of their cognition, their balance, and their bladder control. So this is, again, one of those things that's not that common, but very treatable. And imagine going to the doctor thinking that you have dementia or thinking that you have Parkinson's, and instead finding out that you have normal pressure hydrocephalus, and you get a lumbar puncture, you get a shunt, as I just described, and you get better as a result.

We certainly hope that's the case for your mom, Laura, and obviously for Billy Joel as well.

Thank you to everyone who sent in the questions. Again, I hope that I give you answers that are useful to you. If there's something health-related you've been curious about, don't be shy. Share it. Record a voice memo. Email it to asksanjay at cnn.com. Or give us a call, 470-396-0832. And leave a message, the old-fashioned way. Thanks for listening, and I'll be back next Tuesday.

Chasing Life is a production of CNN Audio. Our podcast is produced by Aaron Mathewson, Jennifer Lai, Grace Walker, Lori Gallaretta, Jesse Remedios, Sophia Sanchez, and Kira Dering. Andrea Kane is our medical writer. Our senior producer is Dan Bloom. Amanda Seeley is our showrunner. Dan Jula is our technical director. And the executive producer of CNN Audio is Steve Liktai. We'll see you next time.

With support from Jameis Andrest, John D'Onora, Haley Thomas, Alex Manasseri, Robert Mathers, Lainey Steinhardt, Nicole Pesereau, and Lisa Namarow. Special thanks to Ben Tinker and Nadia Kanang of CNN Health and Wendy Brundage.

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