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Bruschi at low risk, doctors say

Full stroke recovery called not uncommon

Tedy Bruschi's return to his job as a New England Patriots linebacker tomorrow is unlikely to increase his risk of another stroke because surgeons corrected the heart defect they believe triggered the first attack in February, neurologists said yesterday. As long as the heart surgery works, they said, Bruschi should be in no more danger than anyone else who tackles people for a living.

Bruschi discussed his return to the team at an emotional news conference at Gillette Stadium yesterday, saying that every heart and brain specialist he consulted cleared him to play professional football now rather than waiting until next season. In recent weeks, Bruschi said, he was feeling so much stronger during workouts that he and his wife, Heidi, decided there was no reason to delay his return.

''All of a sudden I came to the point where they tell me I can play," said Bruschi, who will practice with the team tomorrow. ''I feel I can play. I know I can play. Let's just play."

Doctors not involved in Bruschi's care said a total recovery from the kind of stroke Bruschi suffered is not uncommon, especially among young, healthy people like the 32-year-old All-Pro. And, though many older stroke victims suffer a second stroke within a year, Bruschi is at low risk for that as long as the heart surgery he underwent in March eliminated the root cause of the first one, which temporarily left him partially blind in his left eye and unable to walk steadily.

Bruschi's medical team, led by Dr. David Greer of Massachusetts General Hospital, believes that Bruschi suffered the stroke because of a tiny hole between the heart's two upper chambers that allowed a small blood clot to travel from his leg up to his brain, cutting off the blood supply to some of the brain. A month later, he underwent surgery to close the hole -- called a patent foramen ovale, a common birth defect that most people never know they have unless, as with Bruschi, it causes a stroke.

After eight months of treating Bruschi, Greer said recently, the linebacker is ''completely back to normal and is exceptionally healthy." He predicted that Bruschi could play football again ''at a very high level."

''It sounds like a very rational choice as long as his [physical and psychological impairments] are nonexistent," said Dr. Kinan K. Hreib, director of the stroke service at Lahey Clinic in Burlington. ''He'll go back to his good old form again."

If Bruschi succeeds in his comeback, he will become a trailblazer, returning to the highest level of sports competition after suffering a stroke. Other professional athletes, such as former Houston Astros pitcher J.R. Richard, were unable to return after a stroke. Stroke specialists contacted yesterday could name only one other athlete -- national rodeo champion Stran Smith -- who returned to his former level of ability after a stroke.

Dr. Marc Fisher, a stroke specialist at UMass Memorial Medical Center in Worcester, said people should remember that Bruschi had only a mild stroke -- called a transient ischemic attack -- though he needed assistance from his wife when he walked out of Mass. General last February. His medical team believes he has recovered fully -- with no physical disabilities such as slowed reflexes or reduced vision that could make playing professional football more hazardous.

''If he had come to me and had [met] all of those conditions, I would have given him clearance," said Fisher.

Bruschi's return represents a change of heart from early September when he said flatly that he would not play until 2006. Yesterday, Bruschi said the accelerated schedule had nothing to do with the Patriots' disappointing 3-3 start. He emphasized that he and his wife put his health and commitments to his family ahead of playing professional football.

''This is not something you just go for," he said. ''Come on, I lost my sight. One day you wake up and you can't see your sons very clearly and you can't walk right. I'm not going to jump into something without being 100 percent positive."

Typically, one out of seven stroke victims suffers another stroke within a year, but neurologists said the odds don't apply to Bruschi because most stroke victims have underlying conditions such as atherosclerosis (hardening of the arteries), that can continue to cause strokes.

Bruschi has not clarified exactly how the hole in his heart was closed. If surgeons essentially sewed it shut, said Fisher, playing football shouldn't affect the repair. However, if the hole was closed by an artificial plug, Fisher said the impact of collisions on a football field could raise the risk of the plug dislodging or cracking.

Fisher, who is involved in a major study of the effectiveness of the fabric and metal plugs, said it's difficult to know how much, if any, risk there is because the plugs have not been tested under such conditions.

Bruschi said that right after the stroke, he worried mainly about whether he would recover vision in his left eye. But, six weeks later, Bruschi said his doctors conducted a comprehensive vision test and concluded that his sight had returned.

Since then, Bruschi said, he has seen so many specialists about his recovery prospects that his wife jokes that she is getting a degree in neurology and cardiology. ''We've checked and checked and checked," said Bruschi. ''Every doctor or physician that's seen me has given me clearance."

Dr. David Thaler, director of the stroke center at Tufts-New England Medical Center, said he sees patients like Bruschi ''all the time" who defy the stereotype of stroke victims. He said most stroke victims are much older and suffer from atherosclerosis. However, people like Bruschi and rodeo champion Smith, who also had a hole between the two sides of his heart and whom Thaler treated, have conditions that can be cured and they can go on with their lives.

''I'm not surprised that [Bruschi] has recovered and I'm not surprised that he's been advised it's safe for him to return," said Thaler.

Scott Allen can be reached at allen@globe.com.

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