There Is Treatment For Billy Joel's Hydrocephalus

“NPH has a treatment, which is draining excess fluid from the brain using a surgically inserted shunt," said Dr. Matthew Potts, associate professor of neurological surgery, radiology and neurology at Northwestern University Feinberg School of Medicine. “The important thing is getting the right diagnosis.

“The three classic symptoms of NPH — cognitive/memory problems, issues with balance/gait and urinary incontinence — are very similar to a lot of other things that can happen in older adults. So, some people may be diagnosed with dementia even though it’s NPH. If it happens that it’s caused by NPH, we have a treatment for it.”

The challenge is making the right diagnosis

“There is not one test that says ‘Yes, this is NPH.’ For some patients, fluid will build up and a brain scan (CT scan or MRI) might show it, but that doesn’t mean it’s NPH. Ultimately, it comes down to do the symptoms really fit with the picture physicians see?” Potts said.

Most patients undergo a simulated shunt before actual shunt surgery, he added. “Before offering a shunt, most neurosurgeons will do a test simulating what would happen if they drained the fluid. We place a needle into the lower back to drain the fluid (called a lumbar puncture or spinal tap), which acts as a tiny temporary drain that helps the fluid slowly exit the body through their skin over a few days to simulate if they had a shunt. We ask: Do they get better? If over a few days their balance and gait improve, we say, if we place a shunt, you’ll probably get better. If not, we say it might not be NPH,”Potts said 

Using shunts to treat NPH

“To drain that excess fluid, we put in a shunt during a surgery in which one end goes in the cerebral spinal fluid while the other end usually goes somewhere else in the body — usually the abdomen — to drain the excess fluid.”

The difference between hydrocephalus and NPH

“Hydrocephalus in general means a buildup of cerebral spinal fluid in the brain. The brain constantly produces cerebral spinal fluid and constantly reabsorbs it. Hydrocephalus happens when it is not being reabsorbed. It can be a congenital thing in children or can happen after bleeding, trauma or an infection in the brain.

“NPH is a type of hydrocephalus that is seen typically in older people. The fluid builds up, and it doesn’t necessarily affect the pressure in the brain — hence the ‘normal pressure’ part — but it still affects the brain.”