Jim Bouton and Cerebral Amyloid Angiopathy

Jim Bouton was not good enough to play on his high school baseball team but ended up as a professional All-Star baseball pitcher with the New York Yankees who won both of his starts in the 1964 World Series.  He was also a best-selling author, movie actor, and sportscaster and one of the creators of a bubblegum called "Big League Chew" that was packaged and marketed as a fun imitation of chewing tobacco.  Bouton is perhaps best known for his book, Ball Four, a tell-all diary of his 1969 baseball season that destroyed the myth that baseball was a collection of God-fearing, milk-drinking, faithful husbands, and got him blacklisted by the Yankees.   
 
In 2012, at age 73, Bouton suffered a stroke that caused massive bleeding into the frontal lobe of his brain, which damaged his memory and left him unable to speak, read or write.  A biopsy revealed that he had cerebral amyloid angiopathy (CAA), which increases risk for strokes and dementia.  He became progressively less active or able to take care of himself, and died on July 10, 2019, at age 80, probably from heart failure brought on by inactivity. 
 
Early Life and Career in Baseball
James Alan Bouton was born in Newark, New Jersey, and grew up as a fan of the New York Giants. At age 15 his family moved to Homewood, Illinois, and he went to Bloom High School where he went out for the baseball team.  There he was called "Warm-Up Bouton" because he never got to play in a game.  The star of the high school team was Jerry Colangelo, who went on to own the Arizona Diamondbacks and the Phoenix Suns.  
 
Bouton attended Western Michigan University, was a walk on for the baseball team and was awarded a scholarship for his sophomore year. He played summer baseball and at age 20 was signed by the New York Yankees for $30,000.  In 1962, at age 23, he was brought up to the New York Yankees and appeared in 36 games. The next two years he went 21–7 and 18–13 and played in the 1963 All-Star Game and World Series.  In 1964 he won two world series games, but the Yankees lost the series.  The 1964 season probably ended his outstanding career, as the Yankees never allowed him to recover from one game to the next.  He pitched too often and led the league with 37 starts plus pitching in that year's World Series.  In the following season (1965), his arm was too sore to throw his usual fastball and the Yankees had him spend his time in the bullpen. He responded to the loss of his fastball by learning to throw a knuckleball, but his chronic arm injuries prevented him from being a regular starting pitcher again in the major leagues.  
 


In the 1969 season, he kept a diary of what really happens when baseball players spend every week in a different city, and he and sportswriter Leonard Shecter used it to write Ball Four, the  famous expose on  major league baseball players.  The book caused the other baseball players to be very cruel to Bouton and he left the Yankees the next year.  He was traded to the Houston Astros and also played with the Seattle Pilots and the Atlanta Braves.  Later he became a reporter for New York stations WABC-TV and WCBS-TV, starred in the movie The Long Goodbye (1973), and in the 1976 CBS television series Ball Four.  He also talked about his baseball experiences on the college lecture circuit.  He was one of the originators of "Big League Chew," a bubblegum that came in a tobacco-like pouch to resemble chewing tobacco.  
 
Strokes and Cerebral Amyloid Angiopathy
In 2012, at age 73, Bouten  had a stroke that affected his memory and ability to speak.  First he was told that he had mild cognitive impairment (MCI), a condition that precedes dementia. A biopsy of blood vessels in his brain showed that he had cerebral amyloid angiopathy (CAA), deposits of  protein called amyloid that can weaken blood vessel walls, which increases risk for strokes  caused by bleeding into the brain and dementia.  At this time there are no  treatments or known ways to prevent CAA, but control of high blood pressure is recommended.  Bouten showed increasing signs of dementia and eventually entered hospice care.  He died at age 80, on July 10, 2019, probably from heart failure brought on by inactivity. 
 


Symptoms of a Stroke
Strokes are caused by a shutting off of blood flow to the brain: 80 percent of the time by a clot and 20 percent by a hemorrhage.  After the start of symptoms of a stroke, doctors have only 3 to 4.5 hours to dissolve the clot or withdraw the escaped blood from the brain.  After that, the brain can be damaged permanently (Clinical Guidelines Synopsis, JAMA, July 18, 2019).  
 
If you think you are having a stroke, dial 911.  You must go to an emergency room immediately.   There the doctors will do tests to see if you are having a bleeding or a clotting stroke.  Bleeding strokes are treated by draining blood from the brain. Clotting strokes are usually treated with intravenous drugs to dissolve the clots. If the clots are dissolved quickly enough, the person is likely to have no permanent brain damage.   However, a potential serious side effect of these anti-clotting drugs is that they can increase the risk of bleeding into the brain, particularly in patients who have CAA.  That is what appears to have happened to Jim Bouton.
 
Remember FAST to help you check for the most common symptoms of a stroke:
Face: Smile and see if one side of the face droops.
Arms: Raise both arms. Does one arm drop down?
Speech: Say a short phrase and check for slurred or strange speech
Time: If the answer to any of these is yes, call 911 immediately.  Write down the time symptoms started.
 
Other warning signs include:
Numbness or weakness in your face, arm, or leg, especially on one side
Confusion or trouble understanding other people
Trouble seeing with one or both eyes
Problems walking, staying balanced or coordinated
Dizziness
Severe headache that comes on for no obvious reason
 
James Alan Bouton
March 8, 1939 – July 10, 2019

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