By Joe Bargmann

The hard hits in professional football make it onto the highlight films. But the real bone crunchers, the collisions so brutal that the crowd gasps and the wind rushes out of the players’ lungs — those hits can creep into your dreams.

In the wee hours of February 14, 2005, New England Patriots linebacker Tedy Bruschi was dreaming about ramming headlong into then Pittsburgh Steelers running back Jerome Bettis, a man whose bulk and raw power have earned him the nickname “The Bus.” Bruschi and Bettis had faced off in the conference championships that year. The Patriots won, in part, because Bruschi sacrificed his body — with one violent hit after another — to stop The Bus.

In the dream, Bruschi felt his neck muscles tighten as he mentally replayed the experience of bashing into Bettis. When he awoke, Bruschi lay beside his wife, Heidi, clenching his left fist and trying to regain the feeling in his left arm and leg, which had gone numb. The numbness was so bad, in fact, that he lost his balance when he got up to use the bathroom.

“Are you OK?” asked Heidi, who had stirred when Bruschi left the bed. “I think I slept wrong on my arm or something,” he replied, “and now I have a headache.” But what Bruschi had was more than a headache. At just 31 years old, he’d had a stroke. “The only time I’d ever used the word stroke was on the golf course,” Bruschi says. “I thought strokes only happened to older people or those in poor health. I didn’t know the warning signs. I had no family history of stroke. I was in great shape. I was coming off my best year as a professional athlete. I could only wonder, Why me?”

Bruschi asked a lot more questions in the months following his stroke, and he learned more than he imagined he’d ever know about the mysterious, sudden, and often devastating affliction. Stroke is the leading cause of serious, long-term disability in the United States and the No. 3 cause of death, killing more than 143,000 people a year, according to the Centers for Disease Control and Prevention. And nearly 75 percent of all strokes occur in people older than 65, which put Bruschi in the minority. Of all strokes, less than 15 percent result from a burst blood vessel in the brain, according to the National Stroke Association. The vast majority — more than 87 percent — are ischemic, meaning the stroke is caused by a blood-vessel blockage.

But for Bruschi, the most surprising discovery, by far, was that he could recover — completely. In fact, he rallied miraculously after his stroke and was again playing for the Patriots just eight months later.

The rehab was arduous. Even making the decision to come back was difficult. “I talked to my doctor about it,” Bruschi recalls. “I asked, ‘What model do we have for my recovery? Has anyone ever had a stroke and gone back to playing a professional sport?’ He said, ‘Well, Tedy, you’d be the first.’ I honestly didn’t know whether I wanted to be the ‘experiment’ for this.”

Bruschi was right to be afraid. “In a violent sport, like football, a player could hit his head so hard that it could cause a blood vessel to break, leading to a hemorrhagic, or bleeding, stroke,” says Andrew Jagoda, MD, FACEP, a stroke and head-trauma specialist and the director of The Mount Sinai Medical Center’s emergency department in New York City. “The other thing that happens in football is a lot of trauma to the neck. Damage to a major artery there can lead to a blood clot, which may break loose and travel into the brain, causing a blockage. A stroke occurs when part of the brain is deprived of blood because of the rupture or blockage of an artery.”

Bruschi’s stroke was the result of an arterial blockage — but not for the reason one might suspect, given his profession. Doctors discovered that Bruschi actually had a hole in his heart, a congenital defect, which lead to his stroke. Before he began rehab, the hole was repaired, and Bruschi’s heart ended up better than ever.

The cause of Bruschi’s stroke wasn’t the only anomaly of his case. Strokes are more likely to occur in people 45 or older, not someone in his early 30s, like Bruschi. According to Dr. Jagoda, other factors that increase the risk of stroke include high cholesterol, high blood pressure, and diabetes. While genetics can play a role — heart arrhythmia, blood-vessel abnormalities, polycystic kidney disease, and other conditions transmitted from one generation to another — anything that weakens or otherwise damages the blood vessels can heighten one’s risk of stroke.

“There’s clearly a genetic predisposition to stroke in some people,” Dr. Jagoda says. “But there are other people who put themselves at risk by smoking, eating poorly, and generally failing to control their blood pressure and blood-sugar levels. Keeping these things in check can definitely reduce the risk of stroke. The message is clear: one needs to be cognizant of family history but also, just as important, to pay attention to diet. A high-fat, high-sugar diet and a sedentary lifestyle lead to a higher risk of stroke.”

Needless to say, as a professional athlete Bruschi watches his diet closely and stays in top physical condition; so, when he had his stroke, the typical risk factors didn’t really apply to him. What did apply, however, were the typical symptoms. “I was a classic case,” Bruschi says. “I had numbness on one side of my body, loss of balance and muscular function, a headache, and my vision was impaired.”

Bruschi also reacted to the signs like most people do: by trying to ignore them and explain them away. In fact, he waited a full day after first feeling the numbness in his left arm and leg before seeking medical help.

“I felt invincible,” Bruschi says. “I was 31 and a pro football player. I was used to dealing with pain. You take a hit, it’s bone jarring, but you shake it off. I really thought I was going to be OK. But the next morning, I mean a full day later, my son came into our bedroom. He said, ‘Good morning, Daddy!’ He moved from left to right in front of me, but I only saw him when he flashed on my right side. That’s when I said to Heidi, ‘Call 911.’”

Bruschi spent three days in the hospital receiving treatment to stabilize his condition. He was unsteady on his feet when he left the hospital and literally leaned on Heidi; he leaned on her emotionally for the next several months.

Bruschi’s path back to the football field was paved with doubt and pain, and a whole lot of sweat. But after the cause of his stroke — the hole in his heart — had been discovered and surgically repaired, he began a rigorous rehab regimen. In the beginning, he could barely maintain his balance without help. But within months, he was running to regain his stamina, eating well to put on the weight he’d lost, and lifting weights to get strong enough to return to play for the Patriots.

Today, Bruschi counts his blessings. But in retrospect, he says, he wishes his recovery had been even quicker. “When you play football at the professional level, it’s tough to describe — you just don’t want to be away from it,” he says.

Ultimately, Bruschi’s stroke taught him things about life, and himself, that he applies both on and off the field. “Just because something’s never been done before doesn’t mean you shouldn’t attempt it,” he says. “My coming back to play was new and possibly dangerous. It was something that my wife and I did not agree on, but we fought through the doubt together. To live your life and not take risks would be wrong. It’s been four and a half years since my stroke, and I’m still playing football, living a normal life. If I hadn’t given it a shot, I would have regretted it dearly.”

“That’s not to say I haven’t changed. I used to believe I was invincible, that I alone was responsible for my life. ‘I can handle this.’ That’s a statement I used to use a lot. But now, when someone asks, ‘Tedy, can I help you?,’ I’m not afraid to say yes. You need to listen to people when they’re pulling for you. They want to help you — and you need the help. You have to accept that. Just use all the courage that you have and push through. That’s what I did.”

Recognizing and Reacting to a Stroke

A stroke comes on suddenly and can seem mysterious. After all, it involves the body’s most complex organ — the brain. But it’s not difficult to identify. The nonprofit Stroke Collaborative — a joint effort of the American Academy of Neurology, the American College of Emergency Physicians, and the American Heart Association/American Stroke Association — has come up with Give Me 5 for Stroke, five simple questions to tell when someone is having one:

1. Walk: Is the person’s balance off?
2. Talk: Is the speech slurred or the face droopy?
3. Reach: Is one side weak or numb?
4. See: Is vision all or partly lost?
5. Feel: Is the headache severe?

Dr. Jagoda emphasizes the importance of early detection and says that calling 911 is critical, but he adds that going one step further before a stroke occurs by learning which facilities in your area are certified stroke centers is equally important. For stroke centers near you, visit qualitycheck.org. 

The Clot Buster

Approved by the FDA in 1996 for use in stroke patients, tissue plasminogen activator — commonly known as tPA — is an enzyme that causes the breakdown of blood clots, easing or eliminating stroke symptoms. It has stirred controversy since its introduction mainly because testing of the drug had been limited. However, with subsequent testing, many stroke experts agree that tPA can be greatly beneficial in emergency treatment of stroke patients suffering from a blood-vessel blockage. “There is a little bit of risk with tPA, namely, that instead of dissolving the stroke-causing clot, the drug may cause bleeding on the brain,” says Andrew Jagoda, MD, FACEP. “Brain bleeding occurs in 1 percent of all stroke cases but increases to 6 percent if tPA is used. The use of tPA does not increase the risk of death, and when administered properly, it can reduce the risk of death or severe disability.” Dr. Jagoda says tPA’s benefit is greatest when it’s administered within 90 minutes of the onset of stroke symptoms and that experts agree that in limited cases the drug is beneficial — and still safe — up to three hours after a stroke begins. “You have to know the time of the onset of symptoms for tPA to be used,” he says. “If someone woke up complaining of stroke symptoms, no one would or should take the risk of using tPA.”