Wow! Wow! The release of Dr. Bardack's medical assessment of Clinton is devastating to her. There is no way she can weasel her way out of this. Medically, this is "Put Up or Shut Up"

First, I will repeat my disclaimers from the Right Frontal Lobe Epilepsy essay.

1. I am no fan Of Medusa

2. I admitted to some speculation

3. Since the speculation was necessitated by lack of verifiable medical records, I urged that it was necessary for her medical records to be released.

4. I couldn't help myself: "I told ya so!"

Next, I shall enter the contents of Dr. Bardack's February 5, 2014 medical record, which is not comprehensive but is certainly helpful, after which I will translate from medicalese into English.

Present complaint: blacking out for short periods of time, uncontrollable twitching, memory loss, fatigue. Interim Medical History:

Patient returns stating that she is still having complications following a concussion in December of 2012. She states the blacking out, uncontrollable twitching and memory loss have become worse over the last few months. Patient has been diagnosed with having complex partial seizures in early 2013 and was diagnosed with having early onset Subcortical vascular Dementia in mind 2013. Medical Examination:

Patient shows signs of advancing Subcortical Vascular dementia after a MMSE was performed. The patient scored significantly worse than when tested in 2013. Patient is also showing signs of having more frequent complex partial seizures. Diagnoses:

Complex partial seizures

Subcortical vascular dementia Impression/Plan:

I discussed with the patient at length about the alternatives and we elected to maintain her on the present medications with only increasing her medication for the seizures. I have ordered another MRI to be performed and will schedule another office visit after the test is performed. Lisa R. Bardack, M.D.

Translation:

1. Blacking out for short periods of time could represent:

A. amnesia during complex partial seizure (CPS)

B. sensory overload due to excessive attentional demands

C. both of the above

2. Uncontrollable twitching could represent:

A. sequelae of mTBI-induced upper brainstem injury

B. manifestation of CPS

C. medication side-effects

D. all of the above

3. Memory loss in her case is most likely multifactorial

A. Concussion-induced memory deficit (e.g., temporal lobe)

B. Subcortical Vascular dementia (SVD), also known as Binswanger's disease

C. Sensory overload, which is a common affection after mTBI

D. Medication effect

4. Complex Partial Seizures (CPS)

A form of epilepsy about which I wrote extensively in the first of the series concerning Hillary's neuropathology. For those who may not recall, "partial" means no loss of consciousness--which is different than loss of appropriate environmental responses. "Complex" means the involvement of more than one isolated neurological sign.

5. MMSE

Known as Folstein's MiniMental Status examination. This test has high validity, meaning replicability. It has bee widely used (I have performed thousands of these). The problem is that the test is relatively insensitive to executive tasks (frontal lobe functions). Because it is relatively insensitive, a large drop in MMSE score (whatever that means) is indicative of fairly rapid neurological deterioration.

Dr. Bardack mentioned medications plural. The medications which Dr. Bardack alluded to in press-release like medical report of 2015 do not include anticonvulsants, movement control agents, psychotropic drugs. I pointed this discrepancy out in my prior essay.

I have spent the past 9 days researching dural sinus thrombosis, PCS and advanced imaging of neuropathology. Needless to say, I did not suspect SVD. As such, I have not collected any literature concerning that diagnosis.

What I can tell you now (unfortunately without the supporting literature) is that SVD:

1. irreversible

2. progressive

3. treated only symptomatically.

If her MMSE is falling significantly, that is a very bad sign--it means that before her four year term in office is completed, she will be medically incompetent due to severely diminished cognitive functions--sustained attention, working memory, multi-tasking, sensory overload, increasing physical fatigue secondary to attempted cognitive effort.

Some other points of interest:

1. PCS is due to cortical disease, not due to SVD. Therefore there are at least two anatomical loci of pathology: gray matter AND white matter.

2. Chronic use of anti-convulsants, especially at high dose has been known to cause Major Depressive Disorder (MDD)

3. The head-bobbing about which I commented in the first essay could be: upper-brainstem related or PCS related.

4. Psuedobulbar affect is most often due to midbrain pathology, although other loci of disease may responsible.

5. Let's not forget the laughter: she could have gelastic epilepsy which is a form of PCS.

6. Somewhere I remember seeing a video of HRC, reading from a teleprompter. On the teleprompter was the direction: "sigh"

At first I took this as a measure of her literal-mindedness; but now, on further reflection, I think the verbalization of the word sigh was due to diminished set-shifting. Impaired set-shifting is a cardinal manifestation of microneuropathology in people who have significant post-concussion syndrome. Somewhere along the line, Bill Clinton admitted that it took 6 months for her to come back to baseline. Even if that is true, though it probably is an underestimate, that signifies a more severe injury that the average mTBI in which symptomatic recovery occurs within 3 months.

A few words of explanation of commonly used medical terms:

1. Concussion: although very frequently accompanied by loss of consciousness, said loss of consciousness is not a necessary component of concussion.

2. MRI = Magnetic Resonance Imaging. MRI is a painless non-invasive procedure (unless IV injection of paramagnetic contrast is used). MRIs typically done for screening purposes contain only 5 (out of more than a dozen available) pulse sequences. The major pulse sequences are useful, but somewhat insensitive to determining macromolecular pathology. Macromolecular means fairly large anatomic clusters of tissue. Even if the MRI is positive for macromolecular lesions, it does not tells us about the functionality of the neural networks involved.

Macromolecular pathology has three components, but requires use of non-routine pulse sequences. The three domains of pathology detected are: structural (but on a much finer scale than on routine MRI), functional, and biochemical.

MRI is an extremely interesting modality and is becoming simultaneously more complex and more useful rapidly. For those of you that wish, I can reference a very good historical review of neuroimaging, starting from the skull x-ray to today's forays into magnetic resonance spectroscopy, diffusion tense imaging, and even more lately sodium ionic locations.

Let me conclude with this: I was preparing to write at least two more essays about Hillary's neuropathology including neuroanatomic concomitants of mTBI, especially when associated with post-concussion syndrome. The other contemplated essay was about the pathophysiology of Cerebral Dural Sinus Thrombosis.

One more note: CVD is not due to trauma. It is subcortical and involves white matter tracts. It is progressive--and in fact manifestations of Clinton's various neuropathologist (there is more than one) seem to be occurring at an accelerated pace--which is to be expected in view of the high stress levels, increased demand for cognitive functioning, and reduced physical stamina due to post-concussion syndrome.

My educated guess: Hillary will be unable to mask her several neuropathological disorders well before election day.

Once again, I invite your comments. Please refer this essay and the first widely. I don't do social medial. Please do the country a favor and SPREAD THE WORD.