LACUNAR STROKE IN A HYPERTENSIVE FOOTBALL PLAYER - IMPLICATIONS IN MANAGING HYPERTENSION IN ATHLETES

Purpose: A 28-year-old hypertensive professional football player suffe red a lacunar stroke. Given the rarity of stroke at this young age, th e contributory roles of hypertension and competitive athletics merit c onsideration. Case summary: A 28-year-old defensive lineman, with long -standing, albeit recently well-controlled hypertension, experienced s lurred speech and veering to his right after a game. Computerized tomo graphy revealed a small internal capsule infarct. Diagnostic investiga tion, including coagulation profiling, sickle screen, antiphospholipid antibody, carotid imaging, and echocardiography did not reveal a caus e. The patient recovered within days with no residual impairment. Disc ussion: Despite the extreme blood pressure elevation associated with i sometric straining in young athletes, stroke almost never occurs. Vasc ular changes resulting from chronic hypertension and/or marked volume depletion, and hemoconcentration resulting from restricted salt intake , diuretic use, and heavy sweating, offer the only explanations for th is stroke. Relevance: The case suggests physicians should exercise cau tion in using diuretics and salt-restricted diets to treat hypertensiv e athletes. Guidelines for treatment are discussed.