Hillary’s stroke – II

Hillary Clinton decimated Bernie Sanders in the New York primary and is the likely nominee. This makes the nature of her illness in December 2012 even more important. This retired board certified Neurologist and Neurology Board examiner thinks she had a stroke back then. Here’s why.

First: a timeline.

At some point in the week of 9 December 2012 Mrs. Clinton is said to have fainted suffering a concussion. The New York Times reported on this 13 December.

She remained at home until 30 December at which point she was admitted to New York-Presbyterian Hospital when a blood clot was found in a vein draining her brain.

Subsequently she had double vision due to her eye muscles not working together for a month or so and had to wear special glasses (Fresnel lenses) to correct this.

Second: The following explanation for these events was given by Lisa Bardach M. D, a board certified internist in a letter released by the Clinton campaign 31 July 2015.

You may read the entire letter at http://online.wsj.com/public/resources/documents/clintonhealth2015.pdf but the relevant paragraph is directly quoted below.

“In December of 2012, Mrs. Clinton suffered a stomach virus after traveling, became dehydrated, fainted and sustained a concussion. During follow up evaluations, Mrs. Clinton was found to have a transverse sinus venous thrombosis and began anticoagulation therapy to dissolve the clot. As a result of the concussion, Mrs. Clinton also experienced double vision for a period of time and benefited from wearing glasses with a Fresnel Prism. Her concussion including the double vision, resolved within two months and she discontinued the use of the prism. She had followup testing in 2013, which revealed complete resolution of the effects of the concussion as well as total dissolution of the thrombosis. Mrs. Clinton also tested negative for all clotting disorders. As a precaution, however, it was decided to continue her on daily anticoagulation.”

In my opinion this letter essentially proves that Mrs. Clinton had a stroke.

Third: Why should you believe what yours truly, a neurologist and not a neurosurgeon says about the minimal likelihood of this clot being due to the head trauma she sustained when she fainted? Neurologists rarely deal with acute head trauma although when the smoke clears we see plenty of its long term side effects (post-traumatic epilepsy, cognitive and coordination problems etc. etc.). I saw plenty of it in soldiers when I was in the service ’68 – ’70, but this was after they’d been stabilized and shipped stateside. However, I had an intense 42 month experience managing acute head injuries.

To get my kids through college, I took a job working for two busy neurosurgeons. When I got there, I was informed that I’d be on call every other night and weekend, taking first call with one of the neurosurgeons backing me up. Fortunately, my neurosurgical backup was excellent, and I learned and now know far more about acute head trauma than any neurologist should. We admitted some of the head trauma cases to our service, but most cases had trauma to other parts of the body, so a general surgeon would run the show with our group as consultants. I was the initial consultant in half the cases. When I saw them initially, I followed the patients until discharge. On weekends I covered all our patients and all our consults, usually well over 20 people.

We are told that Hillary had a clot in one of the large draining veins in the back of her head (the transverse dural venous sinus). I’d guess that I saw over 300 cases of head trauma,but I never saw a clot develop in a dural sinus due to the trauma. I’ve spoken to two neuroradiologists still in practice, and they can’t recall seeing such a clot without a skull fracture over the sinus. Such a fracture has never been mentioned at any time about Hillary.

Fourth: Why does the letter essentially prove Hillary had a stroke back then ?

I find it impossible to believe that the double vision occurred when she fainted. No MD in their right mind would not immediately hospitalize for observation in a case of head trauma with a neurologic deficit such as double vision. This is just as true for the most indigent patient as for the Secretary of State. I suppose it’s possible that the double vision came up right away, and Dr. Bardach was talked into following her at home. Docs can be bent to the whims of the rich and powerful. Witness Michael Jackson talking his doc to giving him Diprivan at home, something that should never be given outside the OR or the ICU due to the need for minute to minute monitoring.

My guess was that the double vision came up later — probably after Christmas. Who gets admitted to the hospital the day before New Year’s Eve? Only those with symptoms requiring immediate attention.

Dr. Bardack’s letter states, “As a precaution,however, it was decided to continue her on daily anticoagulation.” I couldn’t agree more. However, this is essentially an admission that she is at significant risk to have more blood clots. While anticoagulation is not without its own risks, it’s a lot safer now than it used to be. Chronic anticoagulation is no walk in the park for the patient (or for the doctor). The most difficult cases of head trauma we had to treat were those on anticoagulants. They always bled more.

Dr. Bardack’s letter is quite clever. She never comes out and actually says that the head trauma caused the clot, but by the juxtaposition of the first two sentences, the reader is led to that conclusion. Suppose, Dr. Bardack was convinced that the trauma did cause the clot. Then there would be no reason for her to subject Mrs. Clinton to the risks of anticoagulation, given that the causative agent was no longer present. In all the cases of head trauma we saw, we never prescribed anticoagulants on discharge (unless we had to for non-neurosurgical reasons).

This is not a criticism of Dr. Bardach’s use of anticoagulation, spontaneous clots tend to recur and anticoagulation is standard treatment. I highly doubt that the trauma had anything at all to do with the blood clot in the transverse sinus. It is even possible that the clot was there all the time and caused the faint in early December.

Fifth: Isn’t this really speculation? Yes it is and this is typical of medical practice where docs do the best they can with the information they have while always wishing for more. The Clinton campaign has chosen to release precious little.

So what information would be useful? First Dr. Bardach’s office notes. I’m sure Mrs. Clinton was seen the day she fainted, and subsequently. They would tell us when the double vision came up. Second the admission history and physical and discharge summary from NY Pres. Her radiologic studies (not just the reports) — plain skull film, CT (if done), MRI (if done) should be available.

Sixth: why is this important.Fortunately, Mrs. Clinton has recovered. However, statistically a person who has had one stroke is far more likely to have another than a person who has never had one. This is particularly true when we don’t know what caused the first (as in this case).

We’ve had two presidents neurologically impaired by stroke in the past century (Woodrow Wilson after World War I and Franklin Delano Roosevelt at Yalta). The decision they made in that state were not happy for the USA or the world.

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  • Thomas McKenzie  On August 7, 2015 at 2:55 am

    Is it wise to make a diagnosis of a patient you have not personally examined? I understand the fun in doing so. After all even Freud analyzed long dead historical figures. But still.

  • luysii  On August 7, 2015 at 10:58 am

    Thomas McKenzie — thanks for commenting:

    Medicine has a very different culture. Go to grand rounds at any hospital and you are likely to find difficult cases discussed (with no patient present) given just the history, lab and physical findings (as we have for Hillary) Then people offer their opinions as to what is going on.

    I agree that doing this sort of thing with long dead historical figures is quite chancy.

    All docs are taught to formulate differential diagnoses of a given case, with the most likely possibility first (with reasons) followed by less likely ones. Things in medicine are rarely clear cut.

    As a board Examiner for the American Board of Psychiatry and Neurology, I always looked for how many reasonable alternative diagnoses a candidate could come up with.

    Consider the case of Hugo Chavez, who pronounced himself cured of cancer in July of 2012, when he clearly was not. He won election 3 months later and died in March of 2013. It was obvious to me from what little information released, that he was seriously ill almost from the time when his first operation was announced. For details please see https://luysii.wordpress.com/2013/03/05/q-e-d/

    So the health of our presidential candidates is a significant issue. If Christie gets the nomination, his weight is sure to be a (reasonable) issue, just as Reagan’s age was back in the day.

  • Am I Lloyd  On August 11, 2015 at 9:43 am

    There are a lot of medical facts about Hilary Clinton that are admittedly not in the public domain. Given her importance to the election, it is likely that even her physician is not reporting all the facts. In the light of this incomplete information I think it’s speculative at best (you yourself said that we are missing some key facts).

  • luysii  On August 11, 2015 at 10:28 am

    Am I Lloyd — I quite agree that this is speculative. There is all sorts of data I’d like to have (a really accurate timeline of when the double vision began, Dr. Bardack’s office notes from December 2012, copies of the CTs and MRIs at NY Presbyterian, the neurosurgeon and attending physician’s evaluations etc. etc.).

    You must realize that MDs are always dealing with less complete data than they’d like to have, basing their diagnoses on what they have currently. It’s why cases always have differential diagnoses which are always provisional and subject to revision as new information arises (and not “the diagnosis”).

    For how misleading selective release of information can be see the story of Hugo Chavez https://luysii.wordpress.com/2013/03/05/q-e-d/.

    “Given her importance to the election, it is likely that even her physician is not reporting all the facts.” My guess here is that you are correct and that what hasn’t been released (see above) is likely far more important diagnostically than what’s come out so far.

    The issue is far too important to just sit back and accept what the campaign has provided thus far.

  • Alan  On March 27, 2016 at 10:03 am

    Any opinion of the return of the prism glasses?

  • luysii  On March 27, 2016 at 2:22 pm

    Alan: As far as I know, Ms. Clinton hasn’t worn them since early 2013. As noted in the post, their use in January 2013 implies a fixed neurologic deficit lasting over a week which, with the known blood clot found in December of 12, is the very definition of a stroke.

    What evidence is there that she has started using them again? I didn’t find any in the link you sent.

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