In late February 2025, when Rock and Roll Hall of Fame inductee Billy Joel tripped and fell during a concert, fans quickly took to sites like TikTok and YouTube to share videos of the incident. However, the reason behind what some perceived as a collapse remained unclear until Joel took to his official Instagram page in March 2025 to announce the rescheduling of several of his upcoming national and international concert tours.
Though the March announcement lacked detailed medical information, it did mention a surgical procedure. Joel also expressed gratitude to his fans with a heartfelt message: “While I regret postponing any shows, my health must come first. I look forward to getting back on stage and sharing the joy of live music with our amazing fans.”
It wasn’t until a subsequent Instagram update on May 23, 2025, that Joel provided more specific information regarding his diagnosis. In his statement, Joel revealed that he was suffering from a medical condition known as normal pressure hydrocephalus, which required immediate treatment, leading him to cancel all scheduled performances.
What is normal pressure hydrocephalus?
Normal pressure hydrocephalus is a disorder characterized by a build-up of cerebrospinal fluid in the brain. As the fluid increases pressure on various areas of the brain, normal functions involving cognition, movement, and urinary control may become unreliable. (Here’s what you need to know about an overactive bladder.)
To some, the side effects of normal pressure hydrocephalus, such as memory lapses, may seem to mimic the expected progression of untreatable dementia. According to the Hydrocephalus Association, normal pressure hydrocephalus can resemble symptoms of incurable dementia (e.g., Alzheimer’s disease). However, unlike degenerative dementia, the effects of normal pressure hydrocephalus may be reversible with appropriate interventions and therapies.
Many patients with normal pressure hydrocephalus undergo a surgical procedure to insert a tube (often referred to as a “shunt”) in the brain. The shunt helps drain excess cerebrospinal fluid from the brain to the abdominal walls. This procedure alone may be sufficient for some individuals to recover from normal pressure hydrocephalus. The Hydrocephalus Association reports that approximately eight out of 10 individuals who receive a shunt experience rapid improvements following their initial surgery.
Treatment for normal pressure hydrocephalus
While surgically inserting a shunt is typically the initial treatment for normal pressure hydrocephalus, draining the fluid in and around the brain does not always eliminate the need for further management of patient complications. For instance, patients may still struggle with walking or maintaining balance. Therefore, physical therapy is often recommended alongside the surgery to help drain excess fluid. Physical therapy can be crucial in addressing gait issues; Joel specifically mentioned physical therapy in his May 2025 statement.
Long-term survival rates vary for individuals diagnosed with normal pressure hydrocephalus who have a shunt. According to a 2024 review in Neurology International, the average post-diagnosis survival among patients with shunts was 8.82 years, based on data from 1,614 records. However, some individuals live much longer. The review noted that approximately one-quarter of individuals with normal pressure hydrocephalus were still alive 13 years after receiving a shunt to treat their brain disorder. The review also highlighted that combining therapy with having a shunt could improve survival expectations.
