Does Hillary Clinton have post-concussion syndrome? What this is and why it matters

This is my fourth essay on Hillary Clinton's neuropathology. Once again, I have not received any factually-based rebuttal. And once again, I fervently request that independent evaluators (by which I mean, no connection to Clintons, CGI, or DNC) review this work. As far as speculation is concerned, I freely admit to that charge. The only thing which will validly contravene my speculation are facts. Facts that can be examined by the independent specialists, including epileptologists, physiatrists, neuropsychologists, stroke experts, and neurosurgeons.

It is incumbent upon Hillary Clinton to release her unadulterated medical records for the American people to see, not only is she currently neurologically unfit, but that her dementing illness(es) may make her neurologically incapable of performing her Constitutional duties as Commander-in-Chief of the most powerful nation on the planet.

Notice: My bias is unquestioned--I do not like Hillary Clinton. However all the material quoted in this article is as published in the medically peer-reviewed journals as cited.

Obviously the main subject of this essay is the Post-Concussion Syndrome. This is a complex question, because of the interplay between psychologic and definable neuropathological alterations involved. For many years the post-concussion syndrome was held to be purely psychologic andunrelated to brain trauma.

The above-cited article postulates that PCS-like symptoms are found widely in a non-mTBI population, i.e., that PCS is may be largely non-organically-based. But first, let's find out what PCS is.

Symptoms:
Fatigue; Longer time to think; Poor concentration; Sleep disturbance; Frustration; Forgetfulness; Irritable; Depressed; Headache; Noise sensitivity; Dizziness; Blurred vision; Restlessness; Light sensitivity; Nausea and/or vomiting; Double vision

Postconcussion symptoms (PCS) are experienced following brain injury, particularly mild brain injury. Most descriptions include somatic symptoms (headache, dizziness, and fatigue), cognitive symptoms (poor memory and concentration) and affective symptoms (irritability, emotional liability, depression, and anxiety). Previous studies demonstrated inconsistent findings of the prevalence of PCS. Some appear in the second week. Others found that these symptoms can persist for more than 3 months, or even years. Mittenberg and Strauman (2000) reported that 38% of patients with mild brain injury were diagnosable with Postconcussion Syndrome according to ICD-10 criteria 6 weeks after injury, and 28% of untreated patients met the criteria 6 months after injury. Both organic and psychological factors are thought to contribute to the onset and persistence of PCS.

The patients with brain injury performed significantly worse than the healthy high PCS reporters in most of the neuropsychological test performances.

Let's now see effects on presumably healthy athletes according to neuropsychological examination

The vast majority of concussions in athletes fall at the mild end of the mild traumatic brain injury severity continuum. Loss of consciousness typically is not present, and post-traumatic amnesia is typically brief. This injury is likely associated with low levels of axonal stretch resulting in temporary changes in neurophysiology. Giza and Hovda (2004) described the complex interwoven cellular and vascular changes that occur following concussion as a multilayered neurometabolic cascade. The primary mechanisms include ionic shifts, abnormal energy metabolism, diminished cerebral blood flow, and impaired neurotransmission. Fortunately, for the vast majority of affected cells, there appears to be a reversible series of neurometabolic events. The majority of athletes appear to recover fully within one-month post-injury, but some athletes can have lingering problems.

The model of neuropsychological assessment utilized in sports is distinctly different from more traditional models of neuropsychological evaluation that utilize extensive, time-consuming test batteries. Although there is variability across sports concussion management programs regarding the administration of neuropsychological tests, the interpretation of neuropsychological test data should be conducted by a clinical neuropsychologist who is uniquely qualified to translate the test data into recommendations for clinical management. The timing of the final neuropsychological evaluation has not been determined through consensus nor through empirical research. It is considered prudent, however, to withhold the athlete from contact practice until he or she has recovered neurocognitively. Importantly, some clinicians, especially those working with youth, cautiously prefer to withhold the athlete from any exercise until she or he has recovered from a neurocognitive perspective.

Take home message from the above article:
1. Loss of consciousness is not a prerequisite for diagnosing mTBI
2. Even these "mild" TBIs involve anatomical damage; i.e., axonal stretch injuries
3. Athletes are underdiagnosed
4. Neuropsychological testing should be performed and evaluated by trained neuropsychologists.

Misdiagnosis of PCS certainly occurs, especially in patients with Depression

Depression is the best example of a psychiatric condition that can seriously complicate our understanding of recovery following mild head injury. Many of the specific symptoms of depression, and other problems associated with this condition, are similar to the postconcussion syndrome. For example, the diagnostic criteria for major depression include the following symptoms: (a) diminished ability to think or concentrate, (b) indecisiveness, (c) fatigue or loss of energy, and (d) sleep problems (DSM-IV; American Psychiatric Association, 1994, p. 327). In addition, major depression often is associated with irritability, excessive worry over one’s health, and headaches (American Psychiatric Association, 1994, p. 323). Common lifestyle and psychosocial problems include strained social relationships, marital and family distress, occupational problems, academic problems, and substance abuse (American Psychiatric Association, 1994, p. 323). It is extremely difficult to determine if a person’s self-reported symptoms are due to depression, a persistent postconcussion syndrome, or both because many of the symptoms are identical in these conditions.
Depression has been conceptualized as a multidimensional, system-level disorder affecting discrete yet functionally integrated pathways. Structural imaging studies have revealed volume loss in the ventral medial prefrontal cortex, hippocampus, and amygdala, and functional imaging studies have revealed hypometabolism involving dorsolateral, ventral, and orbital frontal cortices.

Clinicians typically rely on history and self-reported symptoms for diagnosing postconcussion syndrome, although deficits on neuropsychological testing are required to meet DSM-IV Research Criteria.
Based on ICD-10 (World Health Organization, 1992) criteria for postconcussion syndrome, rate the frequency and intensity of 13 symptoms (i.e., headaches, dizziness or light-headedness, nausea or feeling sick, fatigue, sensitivity to noises, irritability, sadness, nervousness or tension, temper problems, poor concentration, memory problems, reading difficulty, and sleep disturbance), and the effect of three life problems on daily living (i.e., greater present versus past effects of alcohol consumption, worrying and dwelling on symptoms, and self-perception of brain damage).

Symptom endorsement was compared to diagnostic criteria for postconcussion syndrome from the ICD-10.
Approximately 9 out of 10 patients with depression met liberal self-report criteria for a postconcussion syndrome and more than 5 out of 10 met conservative criteria for the diagnosis. The current study is the most methodologically rigorous study to date relating to the potential for misdiagnosing persistent postconcussion syndrome in patients with depression. It would be na ̈ıve and biased to assume that (a) because the vast majority of people who sustain uncomplicated mild traumatic brain injuries recover fully, the fact that a person continues to report symptoms two years post-injury indicates that he is exaggerating (or malingering), or (b) because a person currently reports a variety of “postconcussion” symptoms, he continues to be partially disabled from the effects of his mild traumatic brain injury. These are polarized and unscientific positions.

Okay, is it then impossible to separate PCS and depression? Just to remind you, in depressed patients there are significant indicators of structural pathology. People do recover from depression, likely due to neuroplasticity--a subject for another day. Yes, there are OBJECTIVE measures to diagnose post-concussion syndrome. After citing several peer-reviewed journal articles about this matter, I will then get to the point of this essay which is why this matters.

Disentangling mTBI and stress reactions

One of the classic features of mild traumatic brain injury, and the presumed cause of impairment after mild traumatic brain injury, is post-concussive symptoms. These symptoms can include problems with memory, balance, and concentration, as well as ringing in the ears, sensitivity to light or sound, and irritability. There has been a long-standing debate about the extent to which postconcussive symptoms are a result of organic or psychological factors, or an interaction between the two. Incontrovertible evidence now shows that psychological factors play a significant role in postconcussive symptoms; one recent study showed that postconcussive symptoms occur at similar rates in persons with mild traumatic brain injury and in those with no traumatic brain injury.

Misattributing postconcussive symptoms to brain injury may have unfortunate implications, because it may be concluded that recovery depends on neurologic factors. The evidence suggests that participation in educational programs that normalize the reactions can alleviate postconcussive symptoms. The evidence from Hoge and colleagues, as well as from other studies, that psychological factors account for many postconcussive symptoms suggests that more effective interventions may involve augmenting educational programs with strategies that aim to reduce PTSD and depression.
The finding that mild traumatic brain injury is associated with an increased incidence of PTSD raises interesting possibilities about how mild traumatic brain injury may compound PTSD. Biologic models posit that a fundamental mechanism underpinning PTSD involves an exaggerated response of the amygdala, resulting in impaired regulation by the medial prefrontal cortex. The amygdala is central to the development and expression of conditioned fear reactions, and studies in humans and animals have shown that learning to inhibit these fear reactions involves inhibition by the medial prefrontal cortex. Consistent with this model, patients with PTSD have diminished activation of the medial prefrontal cortex during the processing of fear. Mild traumatic brain injury often involves damage to the prefrontal cortex due to shearing forces of the frontal regions against the skull. It is possible that a person’s capacity to regulate the fear reaction may be impaired after mild traumatic brain injury because the neural networks involved in the regulation of anxiety may be damaged as a result of the mild traumatic brain injury
Mild traumatic brain injury can impair cognitive resources and may compromise the capacity to engage in cognitive strategies to manage the aftermath of a psychological trauma.

So, it is reasonable to assume that, since post-concussion syndrome is largely (or totally) psychological, that there are no objective methods to diagnose PCS. Incorrect. There are multiple means to diagnose mTBI and its psychological sequelae and it's neuroanatomic pathology.

Biochemical markers exist which, at the time of acute mTBI, can predict PCS

Mild traumatic brain injury (MTBI) accounts for about 90% of traumatic brain injuries.1–3 The usual diagnostic criterion for MTBI has been a Glasgow coma scale (GCS) score of 13 to 15.4
Post-traumatic complaints (PTC) comprise a large number of symptoms, including headache, dizziness, drowsiness, loss of memory, and concentration problems. The prevalence of having any complaints six months after the trauma is still estimated to be 20–80%.


MTBI patients have been studied to find prognostic indicators of PTC. It was found that female sex, more advanced age, and prior MTBI are associated with poor outcome. Apart from headache within 24 hours after MTBI, which is also associated with poorer outcome, no associations between presenting MTBI symptoms and outcome have been reported.
Neurone specific enolase (NSE) and S-100B in serum and cerebrospinal fluid have been reported to be markers of cell damage in the human central nervous system. NSE is an isoenzyme of enolase and is located mainly in neurones but also in smooth muscle fibres and adipose tissue.26 S-100 is an acidic calcium binding protein found in the brain as the isoforms S-100B (95%) and S-100A (5%). S-100B is found in high concentrations in glial cells and Schwann cells and is highly specific for lesions of the central nervous system. Serum S-100B and NSE concentration peaks have been measured within six hours following traumatic brain injury and these concentrations seem to reflect the severity of the mechanical disruption of the brain tissue. Serum S-100B concentrations shortly after severe brain injury correlate not only with radiological abnormalities and clinical parameters such as the GCS.

Outcome variables were the severity of 16 PTC six months after the trauma. Rivermead postconcussion symptoms questionnaire, which was developed and standardised by the Oxford Head Injury Service. In the present study, PTC were measured on a visual analogue scales (VAS) with a range of 0–100 mm. Using a VAS score allowed us to measure the severity of the complaints in detail, rather than merely determining the presence or absence of these complaints.
Patients were considered to be fully recovered when severity of PTC at six months was the same as before the trauma (or better). This was considered to be the case when the individual VAS scores of all PTC after six months were lower than the 95th percentiles of the pretraumatic VAS scores of all patients. If one or more VAS scores after six months were higher than the pretraumatic 95th percentile, outcome was defined as “not fully recovered”. This method was chosen instead of individual change scores because preinjury severity of PTC relies on patients’ late self assessment.

Twenty two of 79 patients (28%) were classified as not fully recovered after six months. We tested the clinical value of headache, dizziness, and nausea at the ER in predicting full recovery after six months. Vomiting was not included because only 6% of the patients suffered this symptom. The prevalence of full recovery increased from 50% to 78% as the number of symptoms at the ER decreased from three to zero (table 7).

The presence of headache, dizziness, or nausea at the ER after MTBI is strongly associated with the severity of most PTC after six months. The absence of these symptoms in combination with normal serum marker concentrations within six hours after the trauma seems highly predictive of full recovery after six months.

NSE and S-100 B are not widely available in many hospitals. However the fact that reduced test availability exists does not undermine the validity of this study.

Even in the absence of PCS, "uncomplicated" mTBI can be associated with significant neuroanatomical alterations

Head injury is one of the most common injuries in the Western world, with minor head injury accounting for 70– 90% of the head injury cases [1]. Despite being classified as minor, as clinically determined by a normal or near-normal level of consciousness (Glasgow Coma Scale (GCS) score of 13–15) and a brief period of loss of consciousness or posttraumatic amnesia, a large proportion of patients suffer from a wide variety of symptoms for months after the injury [2–5]. This so-called post-concussion syndrome includes symptoms such as headache, fatigue and cognitive complaints such as memory and attention deficits. Despite the subjective severity of these symptoms, conventional imaging with computed tomography (CT) or magnetic resonance (MR) imaging is generally normal.

A widely accepted hypothesis for an organic origin of the post-concussion syndrome postulates that the symptoms are due to microstructural white matter damage as a result of straining, stretching, deforming or even shearing forces, which is not detectable with conventional neuroimaging

The traumatic axonal injury, which includes both diffuse axonal injury as well as less severe degrees of axonal damage, presumed to underlie the microstructural injury, typically occurs during rapid acceleration and/or deceleration trauma mechanisms at interfaces of tissues with differences in density and rigidity, such as at the corticomedullary junction (subcortical white matter), as well as in the corpus callosum and the rostral brainstem adjacent to the cerebellar peduncles (pontine–mesencephalic junction)

The majority of participants were male (n = 18, 58%) and the mean age was 26.4 years (range, 18–50 years). Neurological examination was normal in all participants. There was no difference between patients and controls regarding age (p = 0.47), gender (p = 0.49), educational level (p = 0.42) or crude cognitive function as measured with the MMSE (p = 0.91; Table 1). The mean patient RPSQ score was 15 (median, 5; range, 0–46). On average, patients were able to return to work 10 days after the injury, whilst two patients had not returned to work at the time of the study.
All but one patient had a history of loss of consciousness or (posttraumatic) amnesia after the injury. Most patients had a GCS score of 15 upon presentation (n = 13, 68.4%); six patients presented with a GCS score of 14.

Post-concussive symptoms are common after minor head injury, but their organic origin has been debated due to the poor correlation between objective imaging abnor- malities and the degree of symptoms. Consistently, both autopsy and in vivo longitudinal volumetric studies report evidence of much more widespread and generalised damage to the brain than visualised with single time point conventional imaging, which has led to the generally accepted idea that conventional neuroimaging studies with CT and MRI underestimate the true extent of brain damage after head injury. The hypothesis that post-concussive symptoms are the result of microstructural brain injury is therefore well recognised.

The microstructural injury is thought to consist of traumatic axonal injury, ranging from the more severe diffuse axonal or true shearing injury to milder degrees of axonal damage. Rotational acceleration and/or deceleration forces occurring at the time of the injury are thought to induce maximal damage, with the corpus callosum, rostral brainstem and subcortical white matter as predilection sites.
Empirical evidence of damage in these regions has been observed in postmortem brains even following very brief periods of recorded loss of consciousness. Three stages of traumatic axonal injury are recognised. The first consists of a biochemical alteration in which the minimally stretched axons do not tear and changes may be transient. In the second stage, the cytoskeleton itself is damaged, accompanied by local swelling and enlargement of the injured axon. In the third stage, axotomy occurs, either primarily or secondarily, in which the axon is severed and antero- and retrograde degeneration follows, leading to a disproportionate reduction in white matter, evidenced by the well-recognised global white matter atrophy in the later stages after head injury.

The correlation of microstructural white matter injury with neuropsychological measures of cognition in mildly and more severely injured patients provides further evidence that microstructural white matter injury results in cognitive deficits. Such neurocognitive deficits, if present following minor head injury, are generally subtle, most commonly affecting working memory and selective attention, which are essential for normal functioning in everyday life.
This is reflected in the time course of post-concussive complaints which, after an initial spontaneous decrease over the course of several weeks after the injury, typically aggravate when patients resume their normal, and more demanding, activities, such as return to work or school.

One more comment about PCS, neuropsychological deficits as seen on MRI

One weakness of this article is that it uses relatively insensitive standard MRI protocols. Most tellingly this study does not use magnetic resonance spectroscopy (MRS), susceptibility weighted imaging (SWI), or diffusion tensor imaging (DTI). These three techniques measure, respectively, neurochemical alterations, micro hemorrhages, or fiber tract (myelinated tissues, i.e., axons) disruption.

In this prospective observational study all the twenty patients with PCS following MTBI had deficits on neuropsychological tests and eleven patients had lesions on MRI. Both the test modalities localized the lesions predominantly to the frontal and temporal lobes. All symptoms were associated with prefrontal dysfunction on neuropsychological testing. Structural lesions as detected on MRI may influence the degree or severity of the problem.

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Having discussed what PCS is, this is why it matters.

Please note that several participants in the following post-mTBI imaging study did not have PCS. VBP = Volume of Brain Parenchyma. Parenchyma means brain tissue in this case.

Persistent neurologic problems are present in 10% and 67% of patients with mild and moderate TBI, respectively, but these figures may substantially underestimate the long-term effects of mild or moderate injury. TBI accounts for 2% of all deaths per year in the United States, and most emergency room visits for TBI (27 of 33 patient encounters for TBI) involve mild injuries that do not require hospital admission. Weeks to months later, these patients with mild or moderate brain injury often return to the clinic, complaining of neurologic and psychological symptoms associated with the original head trauma. Although the correlation of TBI with these persistent deficits is controversial, growing evidence suggests that even mild injury may have greater consequences than formerly assumed.

Previous volumetric imaging studies have demonstrated the presence of brain atrophy after TBI. However, many of these studies were concerned with either regional changes in brain or CSF volume or whole-brain volume changes after severe TB. Hofman et al described a loss of total brain volume after mild TBI and examined its potential relationships with neurocognitive outcome. We set out to further characterize changes in total brain volume in mild or moderate TBI by using a validated quantification method. We also examined some of the potential clinical predictors of volume change.

Inclusion criteria were as follows: 1) mild to moderate closed head injury; 2) no known history or imaging result of CNS disease unrelated to the trauma; 3) area of CNS bleeding, contusion, or infarction smaller than 2.5 cm; 4) patient aged 18 years or older; 5) intrapatient serial MR imaging examinations performed more than 3 months apart (for those in the longitudinal analysis); 6) MR imaging examination performed more than 3 months after injury (for those in the single time-point analysis); and 7) availability of fast spin-echo MR images.

Relative to the control subjects, the trauma group had a significantly greater loss in %VPB (P .022). The rate of decline in VBP was also significantly greater (P .05) in the trauma group; the trauma group lost an average of 0.02 U/d of %VBP, whereas the control subjects lost an average 0.0064 U/d.

Nevertheless, our study presents a number of interesting questions when placed in context with the current literature related to TBI. In general, recovery from a mild concussion appears to progress gradually over 3 months, with the greatest impairment occur- ring within the first several weeks (30). However, evidence from both clinical and basic science investigations suggests that TBI can result not only in persistent or long-term neurologic deficit but also continued decay months to years after the original trauma. In an assessment of recovery and outcomes 5 years after TBI, 8% of patients reported that they felt their condition had deteriorated.

Atrophy could be the ultimate consequence of these MT [magnetization transfer] imaging patterns, and a variety of mechanisms that promote global brain atrophy, beyond trauma-induced necrosis, are currently being elucidated (18, 35–39). The brains of patients with TBI have histopathologic features of Alzheimer disease, and patients with TBI are more likely to develop Alzheimer disease, of which one component is brain atrophy.
Mounting evidence in experimental models, as well as in humans, also suggests that apoptosis occurs and continues months after the initial neuronal insult. A prolonged phase of neurodegeneration has been demonstrated as long as 1 year after injury, in addition to the neuronal damage and cell loss that occurs within hours of the initial trauma. A neurodegenerative or apoptotic process would be a particularly appealing explanation as the pathophysiologic basis of the chronic course of TBI and may suggest avenues of therapeutic intervention. Our data are consistent with this hypothesis, which suggests that TBI results in chronic degeneration.

Is there a difference between mTBI patients without PCS (PCS-) and those with PCS (PCS+)? Yes there is and why this is extremely important. The following study compared two mTBI groups, one with PCS and the other without PCS

Post-concussion syndrome (PCS) following mild traumatic brain injury (mTBI) remains one of the most elusive and challenging pathological conditions. PCS is characterized by the presence of subjective complaints such as fatigue, headaches, sleep disturbance or poor concentration, and induces substantial socio-professional troubles that may last from several months to years. The degree to which PCS is associated with brain lesions is still debated. Several studies have suggested that cognitive and neurobehavioral disorders observed in patients with PCS may be associated with axonal injury . Consequences of mTBI on large-scale brain networks and function in PCS patients remain to be investigated.

Large-scale neural networks are distributed local neural assemblies often linked by long-distance structural connections. Brain networks are thought to form an essential substrate for the performance of most cognitive functions. They can be explored using resting-state fMRI, i.e. in the absence of any explicit task. Resting-state fMRI enables an indirect access to intrinsic neuronal activity through its metabolic and hemodynamics consequences, and has thus provided critical insights into brain function.

Resting-state fMRI networks can be characterized using graph theory, a mathematical framework allowing the exploration of the organizational topology of graphs. Brain graphs are composed of sets of nodes, usually regions of variable size, linked by sets of edges, which can be either structural (white matter fiber tracts) or functional (dynamic synchronization). Graph theory studies have allowed neuroscien- tists to show that neural networks had efficient small-world properties and rich-club organization. Such architecture is suggested to satisfy the competitive demands of brain networks in local and global information processing.

Functional connectivity within the default mode network was correlated to cognitive impairment. It remains unclear whether resting-state brain networks are differently affected in patients with PCS because the consequences of PCS on these networks have not yet been explored.

Mild TBI was defined according to the Head Injury Interdisciplinary Special Interest Group of the American Congress of Rehabilitation Medicine [32]. Trauma-induced physiological disruption of brain function manifested by at least one of the following signs: loss of consciousness of less than 30 min, Glasgow Coma Scale (GCS) score between 13 and 15, post-traumatic amnesia of less than 24 hours, any alteration in mental state at the time of injury (confusion, disorientation...), transient focal neurological deficit. Non-inclusion criteria of mTBI included history of chronic alcohol or drug abuse, previous TBI, contraindications to MRI, intubation and/or presence of a skull fracture and administration of sedatives on arrival in the emergency department, spinal cord injury, neurological signs or multiple disabilities (including at least one life-threatening injury associated), head injury following autolysis, patients with psychiatric or psychological disabilities that may interfere with the evaluation, psychotropic medication at the time of TBI, pre-existing neurological condition, major depressive syndrome. Exclusion criteria were patients not fully participating in the procedure, MRI artifacts or poor image quality (see next section).
Patient and control subjects were matched for age, gender, and socio-cultural level (SCL, function of the number of years of education, ranging from 1 (primary school or less) to 5 (university degree), through 3. Healthy volunteers with no history of neurological or psychiatric disease, no contraindications for MRI, and no mTBI inclusion criteria were also recruited from the local community. From the 40 healthy volunteers initially recruited, 8 were subsequently rejected for MRI-related technical reasons.

We examined longitudinal mTBI-induced functional changes in a global brain network using resting-state fMRI and graph theory in mTBI patients developing or not persistent PCS. Compared with both controls and patients who did not develop PCS, PCS+ patients presented strengthened and wide organizational characteristic changes. Graph properties were increased in temporal regions, predominantly at the subacute phase after the injury, and decreased in frontal regions, mainly at the late phase. These changes were functionally significant in PCS+ patient as they correlated with symptom severity in the frontal lobes.

Over the course of recovery, return to baseline of functional changes were observed in moderate to severe TBI patients, while persistent alterations were observed in symptomatic mTBI patients. Overall, our observations on basic measures (connectivity strength and diversity) are in accordance with the literature. The novelty of this set of data is mostly related to the demonstration of increased connectivity in temporal regions and decreased connectivity in frontal regions in mTBI patients with PCS.

In the spirit of always them laughing (which I seriously doubt any of the readers did: Let's think about Hillary's inappropriate laughter. The commonest cause is upper brainstem dysfunction. Cerebral pathology can do so also. Cerebral means brain tissue within the cranium composed primality of neocortex.

Pseudobulbar affect

Pathological laughing and crying, or pseudobulbar affect (PBA), has been described in patients with neurological disorders such as multiple sclerosis, amyotrophic lateral sclerosis, Alzheimer's disease, stroke, and traumatic brain injury (TBI) since the 19th century (Schiffer 2005). The syndrome is characterized by inappropriate episodes of laughing or crying after minor stimuli. It was first coined a disinhibition of cortical control by Kinnier Wilson in 1924. It was observed in brain disease and seen with mild TBI. It can impair social and occupational function and is largely underrecognized in clinical settings.

Here is another possible cause for Hillary's Gelastic epilepsy

The seizures consisted of brief staring followed by smiling and laughing.

Gelastic seizures (GS) are characterized by bursts of laughter, often associated with other types of seizures, such as, generalized tonic-clonic and atonic seizures, and are poorly responsive to antiepileptic drugs. GS or laughter epilepsy has been described in various epilepsies as arising most commonly from hypothalamic hamartoma, and rarely from temporal or frontal regions.

Here's more on why Hillary's uncontrolled laughter is no laughing matter

Although gelastic seizures are most often intracranially recorded from hypothalamic hamartomas, ictal laughter can also be generated in the frontal lobe. Within the frontal lobe, the mesial and lateral aspects of the superior frontal gyrus, the cingulate gyrus, as well as the orbitofrontal gyrus, have been associated with gelastic seizures based on intracranial EEG recording and electrocortical stimulation…one patient with gelastic seizures due to an orbitofrontal oligoastrocytoma has been described. Seizures lasted a few minutes and consisted of sudden motion arrest, unresponsiveness with or without staring, and followed by suspected mirthful laughter and postictal confusion.

What the above 3 citations mean is that Hillary's uncontrolled laughter is an almost certain sign of neuropathology

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Not Henry Kissinger's picture

CpnxH9tWAAAOpNb.jpg

I saw this and immediately thought of you, Ed.

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The current working assumption appears to be that our Shroedinger's Cat system is still alive. But what if we all suspect it's not, and the real problem is we just can't bring ourselves to open the box?

riverlover's picture

I am nearly 2 weeks out from mTBI, got my staples out, still oozing serum from head bang. Dizziness is decreasing, but I guard by maintaining head attitude, not elevation. I have great posture now! PCP says a month to recover. I was lying on my L side for staple dig out and upon getting up, the room was spinning. I still have dizzy spells, headache seem less. I was instructed to take Tylenol, a liver-killer to one who has little liver function. So flying naked for pain relief. It's okay. Still amnesia with the fall, no recollection except what I am told. I only laugh at my dog.

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Hey! my dear friends or soon-to-be's, JtC could use the donations to keep this site functioning for those of us who can still see the life preserver or flotsam in the water.

katchen's picture

the Ben Garrison commentary below if I had already read your (real and not funny) tribulations. We posted at the same time. I'm glad at least that your dog is making you laugh.

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riverlover's picture

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Hey! my dear friends or soon-to-be's, JtC could use the donations to keep this site functioning for those of us who can still see the life preserver or flotsam in the water.

katchen's picture

Here is some of the commentary Ben Garrison wrote to go along with that cartoon.
It's so awful...but funny:

Hillary doesn’t have good footing lately. She also doesn’t have good standing with many voters, either. She’s corrupt to the core and has tried to cover up endless scandals. She’s above the law, but not above ill-health, however. She’s having more and more trouble covering that up. The coughing fits. The facial ticks. The hideous cackling for no reason. Her weird hole in her tongue. Her seizures. Her forgetfulness. She claims Trump is her husband. She said she wants to tax the middle class. She once said, ‘It takes a village.’ Yes it does, Hillary. It takes a village to help you up the stairs.

https://grrrgraphics.wordpress.com/2016/08/11/weekend-at-hillarys-ben-ga...

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ThoughtfulVoter's picture

This is from an Inquistr article on Hillary's health that I had posted on the part 3 thread, and I'll copy it here too:

But that concussion episode could have far-ranging ramification if Florida neurologist Dr. Daniel Kassicieh is to be believed.

“The recent press reports about Hillary’s health point to the possibility she may yet be suffering the symptoms of post-concussion syndrome,” he said. “Electing someone to be President of the United States who has post-concussion syndrome is a real concern to me.”

He claimed to have treated a lot of patients on post-concussion issues, as well as written extensively about the subject in medical journals. Patients oftentimes react differently following the trauma to the brain.

Some people may feel fatigue, others may have trouble remembering, others may suffer insomnia or sudden sensitivity to noise or bright lights. What’s common, however, is these patients could not “easily multitask,” nor do they find it easy to focus on one task for a long period of time.

http://www.inquisitr.com/3413230/hillary-clinton-is-mentally-ill-alleged...

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Alligator Ed's picture

As my essay shows, especially when combined with my first 3 essays, I believe HRC's problems are a lot worse than even Dr. Kassicieh says. I, too, have treated hundreds of patients with PCS--and a lot of them, certainly not all, showed progressive deterioration. On the other hand I've had PCS patients making recoveries as long as 2 years out from their mTBI--and it wasn't easy for them or their families. Two years seems the cut-off date, at least in my practice to see post-mTBI improvement.

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dervish's picture

Headaches, dizziness, irritability, aside from amitriptyline, there isn't much we can do. The good news is that most get better in time... none get worse. This is not a condition that "deteriorates". Two years out is the typical period by which nearly all are recovered. Seizures are not caused by PCS.

Neurosurgery has no role whatsoever in PCS, this is managed by neurology, but you knew that, right?

The falsehoods in this diary are legion.

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"Obama promised transparency, but Assange is the one who brought it."

Alligator Ed's picture

based on the medical literature rebutting what I say? You are good at criticism without facts--why don't you and your braintrust can come up with some FACTS before you resume your uninformed rants. Put up or shut up--show me facts, man, or STFU

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Except vote against Hillary.

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ThoughtfulVoter's picture

There isn't much we can do except vote against Hillary.

Unfortunately, if Hillary does indeed become President and even part of this cognitive decline is real, we as citizens will ALL be affected by it. This is a MUCH bigger concern than just the vote you may cast.

There will have to be new policies/protocols in DC for a President that may be intermittently impaired. There may be new laws that require screening for any candidate running for public office. And it almost goes without saying, that our country's relationship to the rest of the world could be jeopardized by either blackmail, extortion, or detoriating relationships with other powers. IMHO, it won't be SAFE to have a President who has this type of health issues.

This will become an issue that effects everyone, regardless of their party or whether or not they voted.

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lunachickie's picture

nevermind?

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dervish's picture

What you've put up is a large mess of word salad. It's not so much that there are no facts as that you have connected them in bizarre and untrue ways.

I won't write an essay on this topic because it isn't worth an essay. I've stated clearly elsewhere in your diaries what the facts are as I see them. I have "put up", and I won't shut up as long as you keep posting untrue and misleading information.

Hillary suffered a CSVT in Dec. 2012, from which she has apparently recovered, as would be expected. She is certainly at risk for another one someday, especially because she's likely on coumadin, but overall I doubt that her health risks are remarkably different in that regard from anyone else her age.

The "medical records" you posted, allegedly from Dr. Bardak are almost certainly false. Beyond that, that's about all we know.

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"Obama promised transparency, but Assange is the one who brought it."

but fail to produce evidence. AE has links, quotations, commentary and about a million more words than you are able to produce.

Your evidence? My wife is a neurologist and I'm an RN!

Well, let me remind you of a fact you should already know. Ben Carson is a neurologist and thinks the pyramids were grain storage facilities. He's got multiple legal civil cases pending before the courts, all involving how he harmed children.

So let's be a little more certain about the credentials you keep claiming on a wisp of a thread of a vapor.

Prove it, you lying troll.

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dervish's picture

I'm on the level. But at the end of the day, you aren't the one I need to speak to. This is a legal issue.

People can't just "play doctor" on the internet.

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"Obama promised transparency, but Assange is the one who brought it."

lunachickie's picture

Seriously, that the admin "knows who you are" doesn't make you "on the level". It makes you a poster that's been told to stop with these repeated attacks on the same poster. Please--knock it off. Either write your own post to counter Alligator Ed, or take your repetitive stalking of him to the admin and be done with it.

Yes, that's right, I said "stalking". This is the FOURTH TIME you've done this. Not cool. At all.

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dervish's picture

He's a neurosurgeon. Knowing the difference between the two is pretty basic.

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"Obama promised transparency, but Assange is the one who brought it."

dervish's picture

Look up Ed's first diary. I was the second person to welcome him. I've been here awhile, and am certainly no troll.

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"Obama promised transparency, but Assange is the one who brought it."

TheOtherMaven's picture

Facts, please. Citations, quotations, all that stuff. You and/or your wife ought to know how to write a research paper and what you have to do to back it up. So please do us the same courtesy you would if you were publishing such a paper.

And NO PERSONAL ATTACKS. You wouldn't do that in a research paper, don't inflict it on us.

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There is no justice. There can be no peace.

lunachickie's picture

I think Alligator Ed needs to repost this stuff later on, when it's not going to be attacked by this same person. This is four times now, and I'm really tired of it. It's the same song and dance over and over again.

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see this comment I just posted this morning:

http://caucus99percent.com/comment/155999#comment-155999

I'm very close to closing the comments for this essay.

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gulfgal98's picture

We encourage lively discussion and healthy disagreement. But we also ask everyone to disagree without name calling.

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Do I hear the sound of guillotines being constructed?

“Those who make peaceful revolution impossible will make violent revolution inevitable." ~ President John F. Kennedy

ThoughtfulVoter's picture

Ben Carson is a pediatric neurosurgeon, not a neurologist.

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Anja Geitz's picture

With your so called medical opinion. The same opinion you gave us in the last thread on this topic. In fact you probably could've saved yourself the time and just copied it and pasted it in here.

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There is always Music amongst the trees in the Garden, but our hearts must be very quiet to hear it. ~ Minnie Aumonier

dervish's picture

Read my comment above, wherein I state that there is no real treatment for PCS, beyond (possibly) medications and time.

This is new, what isn't new is further distortions from Ed. PCS is not a condition that deteriorates or worsens with time, the patient heals. He's making this stuff up as he goes. The MO is typical, he cuts and pastes some things from an appropriate source, and then proceeds to concoct falsehoods about what he posted.

This isn't about Hillary, I couldn't care less about her condition one way or the other. This is about misrepresenting medicine and medical practice. I am willing to file a board complaint. That's probably the best option.

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"Obama promised transparency, but Assange is the one who brought it."

Anja Geitz's picture

I don't care what you think nor what you do. Just do it quietly and off this thread.

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There is always Music amongst the trees in the Garden, but our hearts must be very quiet to hear it. ~ Minnie Aumonier

dervish's picture

(usually rude) comments towards me?

Look, I'm pointing out untruths, I'm being specific, there is nothing wrong with that. What would be wrong would be to let those claims go unchallenged.

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"Obama promised transparency, but Assange is the one who brought it."

Anja Geitz's picture

you want to discredit a bloggers reputation on here and call him a liar? You better have more than your fucking say so to prove it. No evidence? Then STFU.

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There is always Music amongst the trees in the Garden, but our hearts must be very quiet to hear it. ~ Minnie Aumonier

dervish's picture

I've called him out repeatedly on specifics. Maybe you haven't noticed. Just above, I called out Ed when he stated that many patients' condition deteriorates as PCS persists, and what I stated is a verifiable fact. Further, what I stated about PCS is quite true. Look it up here.

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"Obama promised transparency, but Assange is the one who brought it."

Jay Elliott's picture

Setting the OP's assertions aside, your position is that Hillary Clinton is a physically and mentally healthy person? Because that seems highly unlikely to me.

The behavior of that guy at the podium saying "keep talking" does not seem like an SS guy or any kind of security guy. That reporter looking horrified tells me that seizure video isn't just editing. Kate McKinnon said in an interview that she couldn't figure out why Hillary laughed inappropriately, and finally decided she did it to stall for time when asked difficult questions -- the significance here is that the inappropriate laughter is so noticeable. Reporters tweeted from the press plane during the winter that they were banned from looking out the window of their plane while Hillary was boarding hers. That photo of men holding Hillary up by her extended arms on the staircase -- first, the official "explanation" is clearly a lie, as there could have been no ice on the steps as it was in the 70s that day, and you can tell from people's clothing in the photo itself that it's not that cold; moreover, when people stumble or slip, you grab them by their torso; you don't hold on to their extended arms unless they need balancing assistance for an extended period of time, with some warning.

I used to think they were hiding her just because she's so unlikable and publicly unpleasant that her polling always goes down when people are exposed to her. But there is an awful lot of evidence FROM THIS YEAR that there's something wrong with her. The corporate media is completely compliant, yet she's launching a podcast instead of doing interviews? Why do that, if not because they can't count on her getting through the interview without revealing a problem?

Your sniping at Alligator Ed would be more resonant if you were addressing the evidence all of us are seeing with our eyes that we are simply not getting plausible explanations for from Clinton's many minions. Maybe those medical records are fake. Maybe that's not a diazapam pen. Maybe that portly dude really is just security. He still isn't interacting with her the way he would under normal security/client circumstances. The staring into space, odd behaviors that sure look like seizures, the struggling to walk up even a small number of steps (again, we have more than one data point suggesting this is a problem; there are also videos of her struggling to mount various podiums), that incredibly long bathroom break during a debate -- all this makes it very hard to believe that she's in good health. So if you're asserting that she is, in fact, in good health, I will discount your opinion. Your credentials are irrelevant in that case.

If you acknowledge there's a tremendous amount of troubling evidence and even more troubling blatant obfuscation in response to that evidence by Hillary's camp, then what's your alternate explanation for her health problems?

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TheOtherMaven's picture

It's crowdsourced, it reports the current consensus (when it isn't being hacked by people with an axe to grind - and yes this has happened quite often, not always in the political field), and it tends to be relatively basic.

If you-generic just want a quick-and-dirty summary, it's usually good enough. For something like this, no. For something like this, follow the reference links (if you can - they are sometimes broken), or research the subject independently.

I should also mention that pissing matches between two (or more) experts who disagree have historically been very, very common in every field of science.

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There is no justice. There can be no peace.

Anja Geitz's picture

With a spouse who is a neurologist and the best you could do for a medical link is Wikipedia? And YOU want to be taken seriously? Seriously?

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There is always Music amongst the trees in the Garden, but our hearts must be very quiet to hear it. ~ Minnie Aumonier

elenacarlena's picture

On occasion neurologists are asked for an opinion about an individual who is in the light of public attention or who has disclosed information about himself/herself through public media. In such circumstances, a neurologist may share with the public his or her expertise about neurologic issues in general. However, it is unethical for a neurologist to offer a professional opinion unless he or she has conducted an examination and has been granted proper authorization for such a statement.

Just sayin.

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including the experts weighing in in the NYT coverage of her health.

Those who have actually treated Hillary and have access to her medical records are prohibited from sharing any medical information except as directed by Hillary (aka press releases). Are you willing to just take Hillary's version of the state of her health as fact, or are you simply content to be in the dark about her health?

"Ethical" is a relative term that can be used to protect integrity or to protect us from the truth.

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Capitalism is the extraordinary belief that the nastiest of men for the nastiest of motives will somehow work for the benefit of all."
- John Maynard Keynes

lunachickie's picture

This is a BLOG. People are allowed to speculate here, on this one. We are not in a court of law. Using that to silence this discussion is wrong. Repeatedly stalking the same subject/poster over it is WRONG.

Just sayin'...

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elenacarlena's picture

Even your average journalist. For someone who claims to be a neurologist and a neurosurgeon to speculate is another. If you read through the ethical arguments over the topic, this is because the fact of being a medical doctor gives their opinion extra weight, so must be much more carefully considered.

There's also a difference between these titles: "Does Hillary have PCS?" and "Hillary has PCS".

Note also that when a magazine published a report from psychiatrists who questioned Barry Goldwater's mental health, Goldwater sued the magazine and won $75,001 in 1969 (almost $500,000 today) for defamation. http://www.mercurynews.com/politics-government/ci_30233560/donald-trumps...

Please at least change your title, Al Ed, to clarify that is it speculative.

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lunachickie's picture

the text (as there have been) I do not believe this applies. Though I continue to agree with you about the declarative titles. I don't know if the last one was changed, but in order to minimize all this damned fuss, I really wish Ed would take that much to heart. It seems a reasonable request, under the particular circumstances.

As for "liability", if Alligator Ed is worried about himself that is one thing. If the blog is worried about "liability issues", then the blog ownership needs to take it up with him and lay out general guidelines for the rest of us, if applicable (ie. if he has to change anything, and why we should all pay heed for our own writing going forward).

Until that happens, we're all adults here. If it's going to get this blog sued, that's one thing, but until the powers that be indicate that is imminent, the harassing intimidation and name-calling must stop. It's not fair to those of us who find this to be an interesting subject and want to discuss it without being name-called ourselves, either. Which is why I suggested that Ed re-post later on.

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Alligator Ed's picture

Anyone that looks,can SEE evidence of them. Admittedly my interpretations are speculative. Why is that? Because Hillary has not released her medical records. It is incumbent upon HRC to release her medical records to the public, where they may be reviewed by impartial medical experts. I've admitted, I am not impartial.

The entire purpose of my setting speculation as fact (which it certainly may not be) although I have cited copious medical literature in support of that speculation. Why am I doing that? When running for President, it is incumbent on the person seeking that office to assure the American People that she or he will be neurologically fit for office, regardless of their politics. So the onus is on Medusa to disprove these speculations with fact--her real, unmodified medical records.

Let me examine her (fat chance), order the proper neuropsychological tests, and the requisite neuroimaging, which is more complex that routine MRI studies, and I will be happy to do so. I have also made the plea that my essays be sent to qualified experts for their review, corrections or rebuttal.

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I hate waking up in the morning to this crap! I'm asking everyone in this thread that is participating in this spectacle to stop right now. Especially you dervish, I see you started it again. If this continues I may have to close comments in this essay, it's really getting tiresome. Folks left previous websites to escape this crap and here it is here. This is getting embarrassing. Stop.

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hester's picture

I want to contribute to the discussion b/c I'm an MD married to a neurologist. I just spoke w him. Do you want me to post or not?

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Don't believe everything you think.

Alligator Ed's picture

Literature references appreciated.

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it's the insults that are a problem, so if you can add to the discussion without the taunting back and forth please do.

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TheOtherMaven's picture

which, however, are not mutually exclusive.

1) There's something wrong with Hillary, as evidenced by (videotape, photographs, reports, anecdotes, etc.)

2) Hillary is a miserable rotten excuse for a human being, with a warped malevolent sense of humor, as evidenced by (videotape, photographs, reports, anecdotes, etc.)

One or the other or both statements may be true - but it is not possible that both are false. (It is possible that other people can be deceived, or deceive themselves, into believing the impossible. You all know what Lincoln said about fooling the people.)

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There is no justice. There can be no peace.

hester's picture

PCS patients do not get worse. Seizures are not a sequelae.

Dervish's first post is correct. This part:

There is no real treatment for PCS

Headaches, dizziness, irritability, aside from amitriptyline, there isn't much we can do. The good news is that most get better in time... none get worse. This is not a condition that "deteriorates". Two years out is the typical period by which nearly all are recovered. Seizures are not caused by PCS.

Neurosurgery has no role whatsoever in PCS, this is managed by neurology.

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Don't believe everything you think.

for the comment sans ad hom.

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hester's picture

the ad hom.

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Don't believe everything you think.

Alligator Ed's picture

I spent a lot of time with literature citations which do show that PCS does get worse, a small percentage, but one that does occur.
In my practice, due to the semi-rural location, I practiced neurology as well as neurosurgery. Therefor I saw many patients from their hospital admission, through and after their discharge from acute rehab.
Nowhere did I contend that PCS causes seizures. What I did do, is to say that mTBI can cause seizures. I have two more essays in the works: one on dural sinus thrombosis (Which like mTBI doesn't always completely resolve) and an essay on post-traumatic epilepsy. In that latter essay I will discuss the "second impact syndrome". The four essays so far have consentrated on video analysis, mTBI (in general), PCS and related neuropathology.

To any physicians on this site--or elsewhere--I welcome your input. But. please, not Wikipedia.

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hester's picture

my share and tbh, I trust the 38 years of experience of my neurologist husband. He practices at a University hospital near our home. He did not say there were no sequelae, he said the sequelae did not worsen after the time period in question had elapsed.

That said, as you know we never say "never" in medicine. There are always outiers and exceptions. Perhaps Hillary is an exception.

In general the maximum damage is early and can remain, though it does not usually worsen after 2 years.

I share your interest in having her release her medical records. I particularly would enjoy seeing the results of a Folstein mini-mental status examination. There are rumors floating around that her exam had deteriorated by 2014. I do not know if that is accurate. If so that is very worrisome in a prospective CIC.

Oh and here's a 2008 video of her cackle, which precedes her concussion: https://www.youtube.com/watch?v=44zwRfXxi5s

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Don't believe everything you think.

TheOtherMaven's picture

Snopes has declared them "fakes", insofar as the images released do not appear to be of papers originating from Dr. Bardack's office. Whether any of the information found in them is factual, we do not know. (The damn things went viral - here's yet another repeater: http://politicianreviews.com/review/hillary-medical-records-revealed-dem... )

We do know that the official story, backed up by an official (and verified) letter from Dr. Bardack, is that Hillary is in good health and has no un-manageable medical conditions. http://talkingpointsmemo.com/livewire/hillary-clinton-medical-records

We also know that Hillary has been caught on videotape acting...oddly, losing her balance, having trouble navigating stairs, seeming to "space out" for seconds or minutes, etc.

Even if she's just developing "senior-itis" (a non-medical catchall term for "problems associated with growing older", it doesn't look too great.

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There is no justice. There can be no peace.

Alligator Ed's picture

husband or any neurologist to read or re-read the article cited in the essay above about Microstrucutural alterations in mild brain trauma. Very clearly, and highlighted was the quote from that article that brain atrophy can be detected years after uncomplicated mTBI. This brain atrophy did not occur immediately because it was global. Since the participants in the report were excluded from study if they had prior mTBI, one can only surmise, in absence of a better alternative, that the mTBI resulted in a PROGRESSIVE degenerative change in brain tissue volume. Another article also cited in this essay concerns white and gray matter loss within a sub-acute period (less than 3 months) or chronic (more than 3 months) following alleged "recovery" from mTBI. That study utilized MRI volumetry. He should reread that too.
In no way did I mean to imply that everyone will face these degenerative changes post-mTBI.

Another topic, which confuses some readers is the distinction between PCS and mTBI. Yes, there is no agreed upon PCS treatment. I didn't even allude to that in any of the four essays.

If not convinced, I have more articles demonstrating the progressive nature of neurodegeneration in SOME cases of mTBI. If you would like to discuss this matter further, please c-mail message me. Thank you for your input.

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who start to deteriorate sometimes many years after they retire? What about Frank Gifford? What about the player who shot himself in the heart so his brain could be examined?

What about Muhammed Ali (yes, I know it was Parkinson's, and it was still a deterioration)?

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WaterLily's picture

But what you describe, I believe, is different. You're talking about chronic traumatic encephalopathy (CTE) -- a condition that develops after repeated blows/injuries to the head. Football players, boxers and MME fighters have been shown to suffer from this, and it does appear to be degenerative.

I don't think you'd experience the same symptoms from a single concussive event, but I really don't know.

Regardless, something is seriously wrong with HRC and I hope someone figures it out definitively.

Thanks for the essay, AE.

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please change the title of this piece to reflect it's speculative nature. As is, it's presented as factual, you do maintain its speculative nature in the essay body buy not in the title. Please change it.

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i did it for you. As owner of this site it's my butt on the line and I don't wish any correspondences from any attorneys be brought upon myself. If you have any problem with this contact me and we'll discuss it.

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MsGrin's picture

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'What we are left with is an agency mandated to ensure transparency and disclosure that is actually working to keep the public in the dark' - Ann M. Ravel, former FEC member

I has to thank you for bringing that to my attention. Biggrin

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orlbucfan's picture

I thought this was snark. Alligator Ed is known for it on here. Smile The US Constitution states that POTUS candidates must be in good health when they run for office. It's constantly ignored (no surprise). Rayguns was already in the throes of beginning Alzheimiers in 1980. His puppet masters didn't care; they had Bush I, and the corporate MSM under control. So, what's the difference now? Rec'd anyway. Smile

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Inner and Outer Space: the Final Frontiers.

lunachickie's picture

the viewing public have any idea in 1980, about Reagan's mental capacities and whether it should be questioned? My recollection is at that time, nobody had a clue, particularly when he was running, prior to 1980.

What we're talking about here, about Mrs. Clinton, is a different thing-the woman has had at least one episode on camera, in public, after declaring she was a candidate.

Idle curiosity--does it say, specifically, this:

must be in good health when they run for office

"when they run"?? I need to get back to work--but if it's that detailed, then yeah, seems to me that the difference is that we may very well have footage that is at direct odds with any claims made by Mrs. Clinton's doctors, that she's "fine".

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TheOtherMaven's picture

that the President (and for that matter the Vice President) is expected to be in good health. Nobody foresaw the possibility of a person with significant physical or mental issues running for or holding either office.

The 25th Amendment was an attempt to lock the stable doors after several horses had already bolted. and doesn't do a terribly good job of it.

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There is no justice. There can be no peace.

lunachickie's picture

is in office, if I understand it correctly. There does not seem to be anything particular covering "the fitness for office" before the office is actually awarded to them.

It is up to us to insist that she be given a clear bill of health, and it must address these things that are not addressed. At minimum, it appears she should be cleared again, as it's been over a year since she was anyway--long before the talk of any issues with Mrs. Clinton's condition being "ongoing".

FWIW, it also appears that no one questioned Reagan's mental capacity seriously until at least 1986 or 87 (when Don Regan came aboard, I think it was he who first noticed behavior that gave way to an eventual Alzheimer's diagnosis).

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Let me try and cut through the mumbo-jumbo with a common-sense statement. Hillary is 68 years old - she will be 69 on Election Day, and if elected would be the second-oldest President after Ronald Reagan. Donald Trump is 70. Bernie Sanders is 74.

The Presidency is a very stressful occupation. Age is a factor. Health is a factor. We now know that Reagan privately showed signs of diminished mental capacity prior to his 2004 Alzheimer's diagnosis.

It's a bad idea to elect a President who is 69 or 70. Which is totally a moot issue because the major political parties have already nominated candidates who are too old. For the sake of comparison, Jill Stein is 66 and Gary Johnson is 63. Before the lectures on "ageism" begin, I'm 63 myself and in reasonably good health - but I would think twice before taking on such a stressful job.

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"We've done the impossible, and that makes us mighty."

gulfgal98's picture

I think it is very wrong to exclude someone from consideration as President due to age alone. It was very obvious to me that Bernie is in excellent physical health and had consistently exhibited energy levels far better than many people younger than him. He actually seemed to thrive on the rigors of the campaign trail.

I happen to be the same age as Clinton and despite being a former athlete and someone who is still physically active and appears to be in much better physical shape than her, I would not want the rigors of the Presidency. I am not sure I totally agree with Alligator Ed's diagnosis, but I do think that Hillary is not in as good a health as she purports to be. I do believe that we, the people, should demand that our candidates show themselves to be up to the stresses, both physical and mental, required of the Presidency.

We have at least one email from Huma Abedin that says that Hillary is often confused. That concerns me, regardless of the cause of her confusion. Also concerning is the video in which she seemed completely lost when interrupted by protesters during a speech and had to be told, not once but twice, by the large black man who accompanies her, to continue to talk. It may be that she does not think well on her feet or is easily ruffled, but those are valid concerns that can be and should be weighed by any voter, regardless of the cause.

As to character, I think most people here and the majority of Americans have grave concerns about the character of both Trump and Clinton. So even if there are physical issues, there are definitely disqualifying character issues for me regarding Trump and Clinton.

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Do I hear the sound of guillotines being constructed?

“Those who make peaceful revolution impossible will make violent revolution inevitable." ~ President John F. Kennedy

CS in AZ's picture

This nails it as far as I'm concerned:

We have at least one email from Huma Abedin that says that Hillary is often confused. That concerns me, regardless of the cause of her confusion. Also concerning is the video in which she seemed completely lost when interrupted by protesters during a speech and had to be told, not once but twice, by the large black man who accompanies her, to continue to talk.

There's also another set of emails between Hillary and Huma Abedin during her tenure at State in which Hillary says she has no idea how information is being transferred, shared, tracked etc. and says a system is needed, to which Huma replies something like "we've been over this. I'll explain it to you when I see you later." Giving a clear picture that Huma Abedin is really the person in charge.

These are verified real emails. No speculation needed.

Then the video of Hillary at a speech, standing there looking dazed while an unknown person comes up to her and says "Keep talking. You're okay. We're not going anywhere." Nothing. So again he says "keep talking" and then she repeats "keep talking" a few times, before finally managing to do so. What the holy hell?

She is a person who is clearly not running her own show. That much we know. The Huma emails alone are clear evidence of that. It makes NO difference if this is because Hillary is too old, too tired, has a medical condition or conditions, or whatever. There is no need to pronounce her as having XYZ brain injury or such-and-such disease to know she's demonstrated a lack of competence as a leader or executive.

This doesn't even get into her character, proven dishonesty, and neoliberal political positions. There are umpteen reasons she shouldn't be president.

To me, all this focus on her possible medical issues is a distraction. It cannot be proven, it causes pointless arguments about details of medical stuff that most of us don't have the expertise to assess, and it's irrelevant! She is incompetent and unacceptable. Why she's incompetent and unacceptable doesn't matter.

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I was all in for Bernie, and I agree he seems fine now but if he were the nominee I would want him to run with a younger, and equally capable and trustworthy, VP just in case.

List of Presidents of the United States by age (average 54 years and 11 months).

Pictures are worth a thousand words...



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"We've done the impossible, and that makes us mighty."

It seems to me that there are enough legitimate concerns about her health that it is essential to keep bringing it up. I have always (well, since 1979 when I had concerns about Reagan) felt that a simple mental status exam should be a requirement for seeking office. We can assume that her doctors will only release what she allows. There's the rub. What can be done about this? How do we force an independent evaluation? I think speculating is actually useful because people should be concerned. Beyond that, I don't know what can be done. I'm open to suggestions. Would an op ed or an ad in a major paper be useful? We wouldn't have to provide a diagnosis, just ask for one based on her instability, change in rate of speech, blank stares, the provision that press not watch her board the plane, etc. How can we be proactive on this?

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One thing I'd like to add: her history of blood clots, one of which possibly precipitated her fall & concussion. In an interview on utube, she says she has a history of blood clots: one in her leg while SOS, one that took longer to recover from & required the prism glasses she wore when testifying about Benghazi (a diagram indicates it sat on the right side between cerebrum & cerebellum in the back of the brain, so affected the visual cortex), and a third was found during a follow-up MRI for the second clot. About the third, she says it was somewhere near her right ear. She says she was told after the second clot she'd be on coumadin 3-6 months, but after the third, that it would probably be the rest of her life. I have no idea where the third was; she made it sound more superficial than where the hypothalamus is. but perhaps not.

Of course, I'm interested in anything that would prevent her being able to take office, but I'm 65 and have no balance issues myself. Nonetheless, I would fall flat if I ever tried to walk in her pointy-toed heels. So, I'm less inclined to think she has a balance problem, than that she has a wardrobe problem.

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Alligator Ed's picture

Next essay on board: dural sinus thrombosis. Both statements made about clot location are correct. The sinus thrombosis was located in the Right lateral sinus, which is between the cerebrum and the cerebellum. From an exterior viewpoint it is behind (or, more appropriately, deep to) the right ear. I am only aware of two venous thromboses: one in her leg and one in the dural sinus. I may be wrong.

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riverlover's picture

Aiyee. Pumps with pointy toes. Ouch!

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Hey! my dear friends or soon-to-be's, JtC could use the donations to keep this site functioning for those of us who can still see the life preserver or flotsam in the water.

ThoughtfulVoter's picture

I have been posting to this site if I find physician comments in the media. I had put this on an earlier thread. It has too much info to quote, but I would point out that this person's comments were not based on the medical records that so far have not been verified, but rather on video clips and media clips from her hospitalization and her own interviews.

http://www.breitbart.com/big-government/2016/08/10/physician-strangely-s...

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elenacarlena's picture

sites, folks would delve a little deeper.

The AAPS is an organization of medical doctors opposed to Obamacare and

Dr. Jane Orient has been called a fear-mongering nutjob

And although Breitbart Unmasked doesn't name their own names, they do say they are anti-Tea Party, to give an idea of their politics.

Also, "Dr." Orient is frequently interviewed for Breitbart. Apparently she is also anti-Medicare, anti-refugee because they might have TB, and pro-DDT for killing the Zika mosquitos (that the cure might be worse than the disease is apparently no problem) http://www.breitbart.com/tag/dr-jane-orient/

Look, I get it, we want something to knock Hill out of the race. But this is not that something. These doctors have questionable reputations at best.

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TheOtherMaven's picture

since Breitbart.com is generally neither discriminating nor authoritative.

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There is no justice. There can be no peace.

elenacarlena's picture

the MSM and many of the left-wing sites have been so coopted by the Clintonites that they will not cover these kinds of stories, and I really have no problem with that.

But after years of watching Jon Stewart flay Faux, I also realize that right wingers just flat try to make up their own facts. So don't let them get away with it. You might find some clues from the wingers about something really going on. But anything that comes from that side has to be double and triple checked. At the least, they're probably distorting.

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during the Benghazi hearings and that's what's going to bring her down, not her health:

Hillary perjury charges

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Beware the bullshit factories.

Alligator Ed's picture

I watched as much of it as I could tolerate, and, yes, I did not notice any faltering, tics, tremors, abnormal eye movements.
This however goes to the point of some of my essays: overt symptomatology is appearing at accelerating pace since that testimony. In my opinion, only an opinion, this is because of the continuing progression of the post-traumatic pathology. Stay tuned for essay on dural sinus thrombosis.

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ThoughtfulVoter's picture

I watched only a bit of the Benghazi tape, but remember at the time thinking that her laughing was likely from some sedative she'd taken to get through the day. Just my opinion at that time.

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