What is normal pressure hydrocephalus: Billy Joel’s brain condition explained

“Piano Man” Billy Joel, age 76, is taking a temporary break from the stage to undergo treatment for his recently diagnosed brain condition, normal pressure hydrocephalus.

NPH is a disorder that occurs when cerebral spinal fluid accumulates in the brain’s ventricles instead of being absorbed, causing the ventricles to expand and resulting in potential brain tissue damage.

This condition is typically found among older patients in their 60s and 70s who present a specific set of symptoms, including difficulty walking and poor balance, urinary incontinence and cognitive decline. In February, Joel fell in the middle of his concert at the Mohegan Sun in Connecticut.

Despite the Hydrocephalus Association estimating that NPH can be found in approximately 700,000 adults, only a small percentage—about 20 percent—are actually diagnosed with the condition. Oftentimes, NPH is misdiagnosed as Parkinson’s, Alzheimer’s or simply aging.

Treatment for NPH usually involves surgery. During the procedure, a small incision is made in the right frontal area, and a catheter is passed through the brain and into the fluid-filled cavity. When the fluid builds up, it can now drain out of the catheter and into a tube (placed under the skin) that deposits it in the abdomen. This procedure, combined with physical therapy, usually alleviates symptoms. Fortunately for our community, this specialized surgical intervention and physical therapy are available at the St. Mary Neuroscience Institute.

“Billy Joel at the Newly Refurbished Nassau Veterans Memorial Coliseum” by slgckgc licensed under CC BY 2.0.

If diagnosed early enough, the prognosis for NPH is often good. So, for Joel fans who still hope to see him hit the stage alongside Rod Stewart, Sting and Stevie Nicks, as he was slated to do through summer 2026, a return to performing is certainly possible. 

In an official statement, the singer said that, although “this condition has been exacerbated by recent concert performances, leading to problems with hearing, vision and balance,” he is undergoing physical therapy amid a “recovery period.”

Additionally, the normal pressure hydrocephalus diagnosis of such a prominent figure could lead to less misdiagnoses, allowing more patients than ever to recognize symptoms early and seek treatment to get their lives back.

Learn more about the treatment of normal pressure hydrocephalus and other conditions at St. Mary Neuroscience Institute.