Possible causes of Tedy Bruschi’s stroke

As has been reported, Patriots linebacker Tedy Bruschi has been hospitalized with some kind of intracerebral bleed. As one can imagine, this is big news here in New England.

Here’s what we know so far:

Patriots linebacker Tedy Bruschi will remain hospitalized while he undergoes additional tests after suffering a broken blood vessel in his head, a Patriots team source told The Boston Globe on Thursday.

Bruschi, who was admitted to Massachusetts General Hospital on Wednesday after complaining of headaches, is “sitting up in bed” and talking, the Globe’s source said. The Pro Bowl player reportedly suffered temporary partial paralysis.

A Patriots spokesman said Wednesday night that Bruschi was in “good condition.”

Boston’s WBZ-TV reported Wednesday that Bruschi had stroke-like symptoms, partial paralysis and blurred vision. A source told The Boston Herald for Thursday’s editions that Bruschi lost partial vision in one eye, but his sight was returning.

There are many causes for intracerebral bleeding. According to UptoDate, this can include “hypertension, trauma, bleeding diatheses, amyloid angiopathy, illicit drug use (mostly amphetamines and cocaine), and vascular malformations (see below). Less frequent causes include bleeding into tumors, aneurysmal rupture, and vasculitis.”

Previously undiagnosed hypertension is possible, but less likely in someone in their early 30’s. Trauma from playing football can certainly predispose one to head bleeds – but it seems that his symptoms occurred rather suddenly and it has been 4 days since he last played football (in the Pro Bowl). Vasculitis and amyloid are also possible, but unlikely – since he would have had prior manifestations of these diseases. Illicit drug use always hovers in the background, but hopefully unlikely in this case.

Vascular malformations are an intriguing possibility. In short, they are abnormal clusters of blood vessels in the brain and occur in 0.1 to 4 percent of the population. There are four distinct types: i) developmental venous abnormalities, ii) capillary telangiectasias, iii) cavernous malformations (CM), and iv) arteriovenous malformations (AVM). The first two are generally the most benign, while the latter two have the most serious neurologic consequences.

Clinically, these disorders can lead to headache, seizures and progressive neurologic deficit. The more dangerous lesions, CMs and AVMs presents in between their 20s and 40s. Tests to consider when looking for these disorders would be an MRI (assuredly already done) as well as angiography. Treatment would depend on what was found.

However, given the fact that a bleed was present, there is going to be the risk of rebleed, no matter what lesion is found. Future risks would include the aforementioned rebleed, seizures, and permanent neurologic disability. Football as a profession generally is not ideal for this diagnosis, and I would not be surprised if his football career is seriously in question.

I wish him and his family all the best.