A stroke is certainly possible after a traumatic experience, neurologists say. What some may disagree on is whether the medical examiner’s ruling in Sicknick’s case adequately accounts for this.
Two men who were arrested for assaulting Sicknick are alleged to have sprayed three officers, including Sicknick, in the face with bear spray.
The medical examiner’s release said Sicknick was sprayed with a chemical substance at about 2:20 pm. He collapsed at about 10 pm and was transported by D.C. Fire and Emergency Medical Services to a local hospital where he died the next evening around 9:30 pm.
The medical examiner’s office did not disclose if Sicknick had any underlying conditions.
“Individuals with preexisting heart disease are more susceptible to these types of events, but they can also occur in individuals who do not have underlying coronary disease or other risk factors for stroke. Stressful events can also trigger a surge in stress hormones, such as cortisol, that activate biological processes that increase the risk of stroke,” Rosman said.
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Dr. Mitch Elkind, the volunteer president of the American Heart Association, said psychological stress or physical exertion can lead to a cardiac problem that can secondarily result in a stroke.
“Traumatic events can lead to stroke,” said Elkind, who is also a professor of neurology and epidemiology at Columbia University. “If the heart is overstressed there could be a heart attack that can lead to blood clot forming in the heart that could migrate to the brain and cause a stroke, or if there is enough stress going on, you could get a heart rhythm disturbance forming a blood clot that goes to the brain.”
Sicknick had what the medical examiner called acute brainstem and cerebellar infarcts due to acute basilar artery thrombosis — a specific type of blood clot in the brain.
This area of the brain is critical for cardiac function. It regulates heartbeat and breathing. “These are a terrible type of stroke because the mortality rate is close to 90% when it’s not treated,” Kowalski said.
He was “shocked, amazed — hell, I don’t know where the hell he’s coming from,” he said.
The news release from the examiner’s office said that the term “natural” is “used when a disease alone causes death. If death is hastened by an injury, the manner of death is not considered natural.”
“It’s not a natural death because of the contributing factors that were quite significant in precipitating his death. They contributed in a real significant way,” Wecht said.
He said with a workers’ compensation kind of case, for example, if someone experienced severe psychological stress that led to a compromise like a stroke, that would constitute a significant contributing factor.
“That moves it out of the category of natural death,” Wecht said.
If he were to make a ruling, if there was a strong case against the people involved in causing that stress it “could well be a homicide.”
“If the circumstances are less definitive, then at the very least you will call it accidental. But no way do I agree this is a natural death,” Wecht said. If the office wanted to “punt,” he could at least have chosen “undetermined.”
“Natural does not seem like the right fit,” Wecht said.
CNN reached out to the medical examiner’s office but did not get a response.
CNN’s Katelyn Polantz, Paul LeBlanc, Ali Zaslav and Whitney Wild contributed to this report.