What is normal pressure hydrocephalus? Billy Joel's condition is often treatable

NBC News

23-05-2025

The brain disorder that forced Billy Joel to cancel his concert tour can cause trouble walking and thinking straight — but is often treatable and can even be reversed, doctors said.
A post on the singer's Instagram Friday said that he was recently diagnosed with normal pressure hydrocephalus and that concert performances exacerbated problems with his 'hearing, vision, and balance.'
The condition is relatively rare, according to the Cleveland Clinic, affecting 'about 5.9% of people over 80.'
It's most commonly diagnosed in older adults, usually showing up around age 70.
Joel is 76 years old.
What is normal pressure hydrocephalus?
Our bodies are constantly trying to keep a steady level of cerebrospinal fluid to cushion the brain and spinal cord, either by making more or absorbing it.
That fluid tends to take up a little more space in older adults because brain volume shrinks as a normal part of the aging process, said Dr. Wajd Al-Holou, a neurosurgeon at the University of Michigan Health.
"But what happens in normal pressure hydrocephalus is an abnormal buildup of fluid that causes brain dysfunction because of the pressure it's putting on the brain," Al-Holou said.
What are the symptoms, and how is it diagnosed?
Patients are often diagnosed after they see a doctor because they — or a family member — concerned they might be developing dementia, which is also more common as people age.
Memory loss, bladder control issues and trouble walking are also common. Patients can have trouble lifting their feet, putting them at risk for stumbling and falling.
Doctors generally do brain imaging, either at CT scan or MRI, Al-Holou said, as well as a variety of neurological testing.
Doctors may also do what's called a lumbar puncture to drain the excess fluid. If the person's symptoms improve, the condition is often diagnosed as normal pressure hydrocephalus, or NPH.
How is NPH treated?
Even though the condition can look like dementia, there's a key difference: normal pressure hydrocephalus is treatable and in many cases reversible if it's caught early.
Commonly, neurosurgeons implant a ventriculoperitoneal shunt into the brain that helps drain the fluid buildup into another part of the body, like the abdomen, where it can be reabsorbed.
A drug called acetazolamide can also be used, as it may help the body decrease the level of fluid on its own. The medicine doesn't work for everyone, Al-Holou said.
It was unclear Friday what kind of treatment Joel would receive. His social media post said that the singer 'is undergoing specific physical therapy,' but did not give details.
That kind of therapy is usually given, doctors said, to help patients regain balance.
Any treatment is more effective if a diagnosis is made quickly. If the condition goes on too long unchecked, it can lead to permanent brain damage, Al-Holou said.
If a loved one seems to be experiencing early signs like troublesome memory loss and difficulty walking, 'they should see a primary care physician or neurologist to investigate further,' he said.