Hillary’s head injury [corrected & updated]

In July Madam Hillary released a physician’s letter declaring her in excellent physical condition and fit to serve as president. TPM has posted the letter here. The physician’s letter addresses the resolution of issues related to what is described as the concussion Clinton sustained in 2012. A reader writes to explore the issues based on his professional experience:

I wanted to bring an issue to your attention. I am an internal medicine physician who does a great deal of forensic work. I work with many patients with brain injuries. Recent events have brought a possibility to mind.

We know that Ms. Clinton suffer a head injury some time ago. You may recall that she fainted and struck her head. We were told that she suffered blood between her brain and skull. That is the definition of a sub-dural hematoma, a very common finding in falls in the elderly. We were told that Ms. Clinton suffered no ill effects from the fall; however, she had to wear special glasses to reduce double vision after this event. By definition, therefore, we know Ms. Clinton suffered brain injury as a result of this intracranial bleeding. People don’t wear corrective glasses of this type unless they have had a brain injury.

This damage to her central nervous system might explain some recent events. Ms. Clinton seemed very wooden when listening to the very tearful story of a death in a person’s family. One of the first things a person with a brain injury looses is the ability to be empathetic. A person with a mild to moderate brain injury also loses the ability to think on her feet. Such a person needs to follow a preplanned script and would have terrible problems, for example, in a press conference. I think there is little doubt that Ms. Clinton suffered a brain injury and she is now dealing with the sequelae of that problem. Other examples come to mind which I won’t take your time to list.

Madam Hillary’s physician declares that all is well, but our correspondent is not so sure. He concludes: “It is frightening to think we could have a brain injured senior citizen as our president.”

CORRECTION: A faithful radiologist/reader from Georgia who performs CT/MRI exams on patients with head injuries writes with a correction that is supported by the letter posted in the TPM link above:

Hillary had thrombosis of a transverse sinus which is essentially a large vein at the base of the brain. She did not have a subdural hemorrhage according to reports of the injury. Subdural hemorrhage indicates a more serious degree of head injury.

I appreciate the correction and regret the error.

UPDATE: I asked our radiologist/reader to elaborate on whether the diagnosis indicated in the letter posted at TPM represents a stroke:

“Stroke” indicates death of brain cells due to loss of adequate blood supply. MRI would have shown a stroke (or cerebral infarction) and there are no reports of that condition in Hillary’s case. Transverse sinus thrombosis can cause infarction however, so this internist must be assuming she had an infarction which is being hidden. I doubt that is the case. There can be a venous sinus clot with no infarction…You are probably familiar with patients who develop chest pain and are found to have a coronary artery clot … but get treatment and no infarction occurs. The same can happen with patients who have cerebral arterial or venous clots.

I do [believe] the thrombosis probably occurred prior to her fall. A couple of more facts: 1) Hillary had a history of lower extremity venous thrombosis so she may suffer from a blood clotting disorder…or at least a tendency for clotting if there is no identifiable disease. And 2) she was dehydrated which predisposes anyone to venous thrombosis. Dehydration was probably the primary cause for her problem causing the “faint” with possible contribution of brain ischemia or a transient ischemic attack (short of infarction) secondary to the thrombosis (also caused by dehydration). The analogy is again chest pain from coronary artery clot but no infarction of heart tissue…[T]he faint and fall caused her head injury and concussion symptoms.

I’m leaving it at this for now.