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Neuro Doc: Patterson Might Escape Surgery

BETHLEHEM -- Eagles head athletic trainer Rick Burkholder confirmed a report by ESPN's Sal Paolantonio, that defensive tackle Mike Patterson's collapse yesterday was caused by an AVM, or arteriovenous malformation in his brain.

Burkholder emphasized that a treatment plan was still being formulated, and said he couldn't speculate on what will be required or when or whether Patterson will play again.

Patterson's agent, J.R. Rickert, disputed that the AVM finding was final, stating that Patterson was still being evaluated by "multiple doctors."

"Once we know the course of treatment and timetable for recovery, Mike and his wife Bianca will decide how to proceed," Rickert said in a statement.

Quite conveniently for your Eagletarian, a fan attending practice with a special sideline pass introduced me to another Eaglers enthusiast, wearing a DeSean Jackson jersey. That fellow is Dr. Nirav Shah, a Princeton neurosurgeon. Dr. Shah is not treating Patterson, but he does know a lot about brain AVMs.

"It's where an artery goes right into a vein, without an intervening capillary," Shah said. "It's congenital, not anything that would have been caused by playing football. Oftentimes what happens is, under certain conditions such as stress, dehydration, trauma, and whatnot, these things can tend to hemorrhage. The good thing is, it doesn't sound like he had a brain hemorrhage." (The Eagles said tests yesterday showed no bleeding on the brain.)

"One of the telltale signs is seizures," Shah said. "An angiogram is probably how they diagnosed it. The next part of that is looking at it and seeing if some glue can be placed in within the AVM itself, to stop that flow, or it can be surgically resected, depending on its location."

Traditional surgery, if needed, would require removing part of Patterson's skull. Radiation or "gamma knife" surgery would not, but that typically takes years to resolve the AVM.

"If the AVM is in a very eloquent location, such as the area that controls speech, you wouldn't want to go and operate" conventionally, Shah said. "That (gamma knife) would be a safer option. But the first-line treatment nowadays is actually an interventional technique, just like interventional cardiologists stent an artery, what we try to do is go in through a small blood vessel in the groin and attaxch coils or glue inside the AVM to help prevent it from growing."

Obviously a treatment like that probably would not threaten Patterson's season or career.

"We have a good chance to treat this and cure him of his problem," Shah said.

Apparently, many patients realize they have AVMs only when they experience seizures, as Patterson did on the field Wednesday, biting his tongue and flailing his arms. Patterson remains hospitalized at Lehigh Valley Hospital.

Defensive tackle Trevor Laws, sidelined with a hip flexor, said he has texted with Patterson.

"He said he's feeling all right, just shocked, you know," Laws said. "He's done a bunch of hard workouts, a bunch of hard camps, and this is the first time this has ever happened. He's trying to get his head wrapped around it as much as anything else, at this point."

Laws said he thinks playing football "is probably the last thing on his mind. Football's one thing. Having your brain work right is a whole different story."