Hillary Clinton’s stroke in 2012

Now that Hillary Clinton is the Democratic Party nominee and the campaign has less than 3 months to go, it is time to republish the post of April 2016 so that people can think it over. I am a retired board certified neurologist and former examiner for the American Board of Psychiatry and Neurology.

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 (as of 24 August 2016 nothing more has been forthcoming).

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, of course it is and this is absolutely 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 that we don’t currently have would be useful? First Dr. Bardach’s office notes. I’m sure Mrs. Clinton was seen the day she fainted, and subsequently. The notes would tell us when the double vision arose. 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 decisions they made in that state were not happy for the USA or the world.

Seventh (new): I’ve seen the videos of the ‘seizure’ during a press conference. I find them unconvincing and possibly doctored. The idea that Mrs. Clinton suffers from post-traumatic syndrome seems far fetched to me. She wouldn’t be on anticoagulants if all she did was fall and hit her head. Stay tuned. Mrs. Clinton has not had a press conference in 300 days.
Actually, 264 days. Washington Post keeps a counter on this, which is running as you view the following https://www.washingtonpost.com/news/the-fix/wp/2016/07/07/heres-how-long-it-has-been-since-hillary-clinton-held-a-press-conference/
The debates should be watched closely As Joe Louis (almost) said in another context “[s]he can run but [s]he can’t hide”.

Addendum 11 Sep ’16 — Lest you think that my concern about Mrs. Clinton’s health is something new, or politically driven, have a look at the following post written the last day of 2012. https://luysii.wordpress.com/2012/12/31/medical-tribulations-of-politicians-degrees-of-transparency/. She was but one of 3 politicians I blogged about that day.The initial story about Hillary’s medical problems made no sense to me back then, nor does it now.

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Comments

  • Publius Ovidius Naso  On August 29, 2016 at 9:02 pm

    Here’s the original clip of the possible “seizure,” from one angle only, posted by NBC News, fully in context. The shot from the front is more interesting, but this one also shows the microexpressions of the reporter (Lisa Lerer) who asks the question.

    Here’s a cut with both angles, less context than one might like, and a slow-motion replay which I’m pretty sure is not manipulated.

    It’s good that someone is talking about this in a context without any political BS. It’d be interesting to hear your perspective after seeing better evidence.

  • luysii  On August 29, 2016 at 9:24 pm

    It is rather bizarre, and could conceivably be something called gelastic epilepsy (which usually arises from the hypothalamus) — https://en.wikipedia.org/wiki/Gelastic_seizure
    but it probably is not. I have seen them arise from the medial temporal lobe as well. She appears to fully recover from whatever it was rather rapidly, inconsistent with this being a gelastic seizure. Also, we have no guarantee that what is shown here is unedited, unphotoshopped etc. etc. So take the videos with a large grain of salt.

    Also, thank you very much for realizing that my impetus for the post was having an informed electorate. I wrote something similar about Carly Fiorina when Cruz chose her as his VP nominee — https://luysii.wordpress.com/2016/04/27/carly-s-cancer/

  • luysii  On August 30, 2016 at 1:21 pm

    Lest you think that my concern about Mrs. Clinton’s health is something new, or politically driven, have a look at the following post written the last day of 2012. https://luysii.wordpress.com/2012/12/31/medical-tribulations-of-politicians-degrees-of-transparency/. She was but one of 3 politicians I blogged about that day.

    The initial story about Hillary’s medical problems made no sense to me back then, nor does it now.

  • Joshua Jericho  On September 13, 2016 at 12:07 am

    Excellent analysis. Long time fan of your work.

    Here is incremental, genetic evidence in favor of your hypothesis:

    It appears both of Hillary’s parents had strokes/were on anticoagulant therapy:

    http://gotnews.com/hillary-clinton-suffered-strokes-lets-look-family-history-hillaryshealth/

  • Joshua Jericho  On September 13, 2016 at 12:41 am

    Doubtless you are aware of the latest Clinton contretemps. Both angles are well shown here:

    The Dr. Lisa Bardach, whose letter you’ve analyzed, was accompanying Hillary at the 9/11 event before her fall! There are a series of interesting still photos where Dr. Lisa Bardach is shown apparently monitoring Hillary’s pulse, tracking Hillary’s eye with her pointer finger, and having Hillary squeeze her fingers, e.g., https://theconservativetreehouse.files.wordpress.com/2016/09/hillary-clinton-health-1.jpg?w=640&h=360

    All of which appear to my amateur eye to be basic neurological checks.

    The series of alibis do not appear sufficient or convincing–a benign, random cough, allergies, heat exhaustion, and now pneumonia. The troubling thing about Hillary is the volatility in her health, and a respiratory ailment does not really seem to fully describe reality here.

    Many–frankly somewhat paranoid, and conspiratorial sounding–independent conservative sources have pointed this out and are proffering some more serious diagnosis, like Parkinson’s.

    In light of recent events, I would appreciate your analysis clarifying/confirming/debunking some of these more troubling hypotheses.

  • Joshua Jericho  On September 13, 2016 at 1:21 am

    All this Dr.’s videos:
    https://www.youtube.com/channel/UCI2FhX0p9P8ODPP0nixR3bw

    Here is one of the better, more sober cases for a Hillary’s Parkinson’s diagnosis. Previously, I had chalked up her coughing spells to adverse effects of her thyroid medication. But I’ve been reading reports that her staff can’t get her to drink water; she doesn’t want to, which I suppose is also consistent with her having Parkinson’s related swallowing issues.

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