Athletes Not Immune To Strokes

FAYETTEVILLE — Something was wrong with Brian Mullen. The professional hockey player didn't feel right that August day in 1993. His keys unusually fell out of his hands several times. He was stumbling around, too, for unknown reasons. And he had trouble speaking, slurring his words.

Mullen, who was playing in the NHL for the New York Islanders, was in his early 30s. He was in great shape, preparing for his 12th season in the league. So he wasn't exactly expecting what doctors eventually told him.

How could he have suffered a stroke?

"My whole world was turned upside down," Mullen, now 47, said in a phone interview. "You think, why me? What's going on? How did this happen? How could it happen?"

Mullen understands what Arkansas receiver Joe Adams must have felt a couple of weeks ago, when the Razorbacks discovered the 19-year-old sophomore had suffered what coach Bobby Petrino has described as a "minor stroke."

The exact details of Adams' medical condition have not been revealed by Arkansas because of the Health Insurance Portability and Accountability Act (HIPAA). But the diagnosis was, no doubt, stunning, considering strokes are typically associated with older people. And especially since Adams was racing through Texas A&M's secondary during Arkansas' 47-19 win days earlier in Cowboys Stadium.

Adams — who has not been available for comment since suffering his stroke — will miss his third straight game today when the Razorbacks play Ole Miss in Oxford. But he has shown signs of improvement this week. He participated in light work Tuesday and was involved in portions of practice Wednesday, leaving Arkansas optimistic about his recovery.

The experience has been an eye-opener for all, though.

"It makes us all think a little bit," Adams' teammate, receiver Jarius Wright said. "There's always that, ‘What if,' factor. But at the same time it's football and it's life and things happen and it's not always for the best. But you've got to learn to deal with them and go along with them."

An Unusual Find

By definition, a stroke occurs when blood flow to the brain is hindered. The American Stroke Association's Web site explains there are two types of strokes. Blood vessels can clog blood flow to the brain (an ischemic stroke) or vessels rupture and blood leaks into the brain (hemorrhagic stroke).

There also are transient ischemic attacks (TIA), which are regarded as warning strokes. They are caused by a small clot. But, unlike a stroke, the blockage is only temporary.

Adams' exact case is unknown, but Petrino offered a peek into its discovery last week. He said Adams' biggest warning sign was a severe headache. Adams was initially treated for a migraine, but the issue re-emerged later in the week and it led to the discovery of his minor stroke.

Dr. Al Gordon, Arkansas' medical director, said pre-existing medical conditions often play a role in strokes in young athletes. He couldn't comment on the details of Adams' case, but said treating an athlete for a stroke is unusual.

"Quite frankly, probably, in my 15 years in doing what I do with sports medicine, I've never seen that before," Gordon said Thursday. "I have seen stroke cases in young people in my career, but it's a very, very rare thing."

Dr. Clint Horan, a neurologist at the Northwest Arkansas Neuroscience Institute, said it's not "diminishingly rare," though. On average, he sees one stroke victim a month in their 30s or 40s. Adams is a little out of the norm at 19.

But Dr. Jeanne Wei, the director of the institute on aging at UAMS in Little Rock, believes that advances in the field are proving that strokes suffered by young people in the past may have been "underdiagnosed and underappreciated."

"We are now beginning to understand that stroke occurs more commonly than we previously thought in young people, including children," Wei said. "Previously when these episodes would happen in young people, we would never give them a diagnosis of stroke most of the time. Stroke was pretty much thought to be limited to older adults."

Tackling the Unknown

One of the most well-known stroke cases involving an athlete occurred a few years ago with New England linebacker Tedy Bruschi. The veteran was in his 30s when he suffered a stroke shortly after the 2005 Pro Bowl.

Bruschi's stroke was the result of a patent foramen ovale (PFO), a congenital heart defect. A blood clot moved through a small hole in his heart and lodged in his brain.

Stran Smith, a tie-down roper champion with the Professional Rodeo Cowboys Association, said the stroke he suffered in 2003 was similar to Bruschi's. At the time, Smith only knew of older people suffering strokes. The fact that it happened to a healthy professional athlete was frightening.

"The unknown was probably the scariest thing about it," Smith said of his stroke, which only affected his speech. "Finally figuring out what caused the stroke was somewhat of a relief. But then the unknown of what do you do now?"

Smith — like Bruschi — underwent surgery to repair the heart defect. It didn't take long before he was able to resume a career he continues today. The same for Bruschi, who played three more full seasons before retiring in 2008.

Not every stroke case in athletes ends in success, though.

Former Houston Astros pitcher J.R. Richard suffered a stroke in 1980, derailing his promising career. Mullen never played in another NHL game, largely because of a seizure he suffered during practice several months after his stroke.

"Growing up as an athlete, you always think you're invincible, and that's the furthest thing from the truth," Mullen said.

Arkansas has made no public promises in regard to Adams' future, other than the fact he continues to improve.

"Joe is very stable," Gordon said. "We're very enthusiastic about how he has responded to his illness. ...

"He's doing everything we ask him to do. He does appear to be recovering very well. So we're very positive about the possibilities for him. But there's still work-up that's being done. So we still honestly do not have the specifics on when and if he's going to actually be back out there."

Road to Recovery

Bruschi's return to the football field was proof that it can be accomplished, even in a high-speed, contact sport.

The severity of the stroke and recovery time differ for individuals. But Smith and Mullen believe there's no reason Adams won't return if everything goes smoothly.

"If he still wants to play, if he still has the desire to play, I would recommend it," Mullen said. "I really wish I would've seen it all the way through."

Anyone who has suffered a stroke is at greater risk of experiencing another than those who have not, according to Horan. He said the risk for the standard stroke population — which is typically older people — is roughly 15 percent. He said probably 10 percent of that risk is in the first year.

But Horan said stroke victims do get back to normal.

"I've never seen a highly trained athlete in that situation," Horan said, speaking of his patients. "But I do have a lot of patients who do recover great from strokes. They ultimately get to where you would never know they had one."

Wei added that the key to bouncing back is being patient and staying aware of the consequences. She said recovery from minor strokes is not unlike other injuries.

"You know how you get a concussion? It doesn't mean you can never go back, but it means you better pay attention and you better take good care of that bruised brain," Wei said. "It's the same kind of thing with a stroke. You had an injury to part of the brain and you should take care of it."

Does it mean Adams will be back in uniform soon?

More answers could come next week. Petrino said Thursday that Adams is expected to see specialists in Little Rock.

If Adams does return, the Razorbacks have made it clear they'll be ecstatic to see him back on the field.

"I hope every day that he's going to be back," offensive coordinator Paul Petrino said. "But more importantly, I hope that he's healthy and fine. So whenever they tell us he's fine, I'll be jumping up and down happy as can be. Until then, I just wish him the best and hope he keeps getting better."

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