Mike Patterson’s Toughest Choice?

If the Eagles defensive tackle has AVM, should he play?

Mike Patterson might be the luckiest man alive. Emphasis on alive.

He’s certainly the luckiest NFL player.

He’s lucky because now he knows. At just 28 years old, the Philadelphia Eagles’ 6-foot-1, 300-pound defensive tackle — who collapsed and suffered a seizure at practice last week in front of frightened and concerned teammates and coaches — knows now that there’s something untoward going on inside his skull.

He also knows it might be treatable.

Many NFL players aren’t so lucky. Too many.

Too many of them suffer unknowingly. Or at least without a definitive diagnosis. They endure symptoms — memory loss, mood changes, irritability. In many cases, their lives spiral downward because of the debilitating effects of their condition. But it is typically too late before they learn they are suffering from a brain disorder.

The NFL is growing into one giant petri dish for chronic traumatic encephalopathy (CTE), a progressive degenerative brain disease. At least 20 deceased NFL players were diagnosed with it. In fact, the disease is becoming so pervasive among athletes in high-collision sports that in 2008 it spawned the Center for the Study of Traumatic Encephalopathy in Boston, a place that houses at least 75 brains of deceased athletes, most of them former NFL players.

The late Chicago Bears star Dave Duerson famously called the center “the NFL’s brain bank.” That, obviously, was before he shot himself in the chest in February because he could no longer endure the suffering he believed was caused by CTE. He wanted his brain sent to Boston for a definitive diagnosis, which proved to be positive for CTE.

I am not suggesting at all that Mike Patterson has CTE, only that he is lucky enough know he has something.

In the ensuing chaos after Patterson’s seizure, the Eagles announced (perhaps a tad prematurely) that he had been diagnosed with a cerebral arteriovenous malformation (AVM), an abnormal bundle of arteries and veins in the brain that is typically congenital, forming before birth.

The announcement enraged Patterson’s agent, JR Rickert, as well as the player’s family, who sought other opinions and have yet to reveal what they have learned. (Calls to Rickert were not returned.)

One leading neurological surgeon, Dr. Bennie W. Chiles III, M.D., an assistant professor of neurosurgery at New York University Medical Center, offers an insight into what Patterson likely endured in the hours after he collapsed, along with his prospects.

“It’s not a hard diagnosis to make at all,” Chiles says.

Chiles’ comments come with his caveat that it is “impossible to say anything definitively without specific knowledge of [Patterson’s] case,” which he doesn’t have. But in all likelihood, he says, Patterson underwent a CT scan (which initially likely revealed the possibility of AVM), then an MRI for a more definitive view. He also probably underwent a cerebral angiogram, then likely was put on anti-seizure medication.

The seizure itself, as frightening as it might have looked to those nearby, was probably not physically traumatic, Chiles says. Call it more of a flare signifying trouble.

“A seizure is uncomfortable but not dangerous,” he says. “The worst thing that can happen with AVM is a hemorrhage. If that happens, you can develop a very significant neurological deficit that could be permanent. But you can have a seizure; and, if you’re in very good shape like it seems Patterson was, it is possible to experience no neurological deficit and come out intact and even well, if it can be treated.”

Indeed, Patterson was released from the hospital after just two days and almost immediately rejoined his teammates at training camp at Lehigh University. He has not been cleared to return to practice, and the Eagles are reportedly (and not surprisingly) taking a cautious approach, no matter the ultimate diagnosis.

AVMs range from small to “hard and complex,” Chiles says. The former are “simple and easy” to treat, while the latter are “impossible.”

A simple AVM can be treated in numerous ways, including surgery to remove it or by inserting a catheter and releasing all or part of it, and with radiation.

“To treat it perfectly, you want to obliterate the whole thing,” Chiles says. “If you can, that’s the cure. If not, then you may perhaps improve the patient’s overall situation [with various treatments], but you haven’t cured the risk.”

Ah, the risk.

No matter the ultimate diagnosis, that’s the real question: How great the risk?

What do the Eagles do if Patterson is cleared to play?

For that matter, what does Patterson do?

What should he do?

That’s the question both the Eagles and Patterson will have to answer for themselves — and without any clear, definitive data to guide them.

“The problem is once you know someone has AVM, it becomes very difficult to allow that person to engage in an activity that involves brain trauma,” Chiles says. “There’s no clear association between having AVM, head trauma and increased risk. But it just doesn’t sound right.”

No, it doesn’t, which is why the Eagles are being cautious about allowing Patterson to return to practice, no matter what the doctors say.

Patterson, understandably, apparently wants to play. He’s played more games (95) than any other current Eagle and wants to return to the most comfortable cocoon he’s ever known.

But at what cost? Or potential cost?

There is no easy answer to either question. No sound-bite solution.

It’s life.

Yet Patterson is lucky to be in position to make the decision about his future — about his life — rather than having it made for him. Tragically, perhaps.


One thought on “Mike Patterson’s Toughest Choice?

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