Only a post-mortem study of the brain of Mike Reynolds, 27, a standout defender for the Baltimore Blast, could reveal what actually caused the stroke that killed him Monday, medical experts say.
And, that seems unlikely now. According to Drew Forrester, a Blast spokesman, no autopsy will take place at the request of Reynolds' family.
But, at least three Baltimore specialists speculated yesterday that the life of the highly regarded player from Toronto probably was snuffed out by an arterial dissection that blocked the flow of blood to his brain.
The specialists said one of two arteries could have been involved:
* The carotid artery, which runs from the heart up the sides of the neck into the brain.
* The vertebral artery, which supplies blood to the back
of the brain, a critical center that regulates breathing, heart rate and blood pressure.
In a dissection, there is a ripping of the lining of the blood vessel, and blood that normally travels through the center of the artery to nourish the brain then flows through the arterial wall, never reaching the brain, which finally dies.
Dr. Barney J. Stern, director of neurology at Sinai Hospital and an associate professor of neurology at Johns Hopkins University, believes that a carotid dissection might have caused Reynolds' death.
"It's been reported in wrestling if someone gets thrown, seen in patients following chiropractic manipulation and in divers where someone has been doing a lot of twists and turns and can injure their neck," Stern said.
The Blast was playing a group of inmates last Saturday in a fun game of soccer-volleyball during which the Blast players used only their heads and feet.
"Reynolds wasn't using his hands to play volleyball, so you can envision that his head may have been twisting and turning to try to return the ball," Stern said. "A carotid dissection is an interesting possibility."
Both the carotid and vertebral arteries are potentially vulnerable to trauma, depending on the position of the head, according to Dr. Thomas J. Preziosi, director of stroke services and associate professor of neurology at Johns Hopkins University.
"These arteries can be bruised, the vertebral more so than the carotid, by various head positions where the artery abuts against one of the cervical vertebrae which has a long bony protrusion and that can initiate a dissection," he said.
In addition, an acute rise in high blood pressure is often thought to be the trigger for arterial dissection, according to Preziosi.
"That might be just enough to tear into the wall of a vessel which has the kind of a wall that is more fragile than other vessel walls," he said. "So, it could have been an acute hypertensive crisis and that frequently happens in people who have high blood pressure."
The son of Lynn Reynolds and Lincoln Reynolds, Mike Reynolds had been battling high blood pressure since he was 16. He had been playing soccer with it all his life. Because of his blood pressure problems, he was sidelined for one year and put on new medication.
Three years ago, he won the Blast's Comeback Player of the Year Award. The next season he won the team's Unsung Heroes Award. He was an All-America defender at George Mason University and was the first pick by the Blast (second round) in the 1986 draft.
Kenny Cooper, the Blast coach, described Reynolds as "a coach's dream -- a really superb human being."
"He was well-medicated and he had good blood pressure when this event happened," said Dr. Larry Gallagher, a Blast team physician and a physician at St. Agnes Hospital. "To the best of my knowledge, his stroke was not related to his hypertension."
Gallagher said that, after analyzing the case and after consulting with several neurologists, he, too, agrees with those who believe that Reynolds suffered an arterial dissection.
"The reason I came to that conclusion is that there was no evidence of hemorrhage on the early CT scan and in the spinal fluid," he said. "So, that ruled out intracranial bleeding. The only other cause of stroke is a blockage of the blood vessels going to the brain."
Strokes are not common among young people, according to Stern. "When they do occur, blockages are more rare than bleeding type of strokes, whereas in older patients that ratio is flipped," he said.
"If there was a hemorrhage in the brain or if an aneurysm, a life-threatening bubble on an artery, had occurred, the CT scan would have revealed it," Stern said. "But, those things apparently were not a cause of this stroke. Further, we know of no existing heart condition that might have caused clots to the brain."
Dr. Thomas R. Price, who heads the University of Maryland Stroke Center, said that treating high blood pressure does not mean the patient gets off scot-free.