Might Hillary Clinton Have Suffered a Stroke?

Via the Drudge-linked PageSix, the latest from the Medical Doctor-Architect Karl Rove:

Karl Rove stunned a conference when he suggested Hillary Clinton might have brain damage.

Onstage with Robert Gibbs and CBS correspondent and “Spies Against Armageddon” co-author Dan Raviv, Rove said Republicans should keep the Benghazi issue alive.

He said if Clinton runs for president, voters must be told what happened when she suffered a fall in December 2012.

The official diagnosis was a blood clot. Rove told the conference near LA Thursday, “Thirty days in the hospital? And when she reappears, she’s wearing glasses that are only for people who have traumatic brain injury? We need to know what’s up with that.”

Americans should think more carefully than Rove about just what Clinton’s illness may have been (and what her susceptibility to illness currently is). 

The Clintons do not exactly tell the truth all the time (but what difference does it make, right?).

And, clearly, if Hillary wants to be president she has an overwhelming incentive to conceal an illness more serious than that which has been publically described.

That much is obvious.

What is not so obvious is that one can accept much of what Clinton said about her illness as true, and yet find that a quite rational conclusion to draw is that she might have suffered a stroke.

And, regardless of whether what Clinton has said about her symptoms and their causal sequence is true, we can be quite confident that the national security apparatus did not just take at face value Clinton’s claims, and the rest of America shouldn’t either -- and not just because Clinton is a known, and in this case extraordinarily incentivized, liar.

So what is the public story on the causal sequence and etiology of Clinton’s illness?  Via NPR on December 15, 2012 we have:  

Secretary of State Hillary Clinton, who earlier this week because she was ill with a stomach virus, is at home recovering from a concussion she suffered in a fall, her spokesman says.

According to an email that State has sent to reporters, Deputy Assistant Secretary of State Philippe Reines says that:

"While suffering from a stomach virus, Secretary Clinton became dehydrated and fainted, sustaining a concussion. She has been recovering at home and will continue to be monitored regularly by her doctors. At their recommendation, she will continue to work from home next week, staying in regular contact with department and other officials.

Clinton therefore asserts a causal sequence running from a stomach virus, through dehydration, followed by fainting, and concluding in a concussion. 

NPR did not mention the official diagnosis of a blood clot, but on January 25, 2013 ABC News suggested that the concussion also appeared to have generated a blood clot and a pair of thick glasses:

The thick glasses Hillary Clinton has been wearing in public since returning from a concussion and blood clot last month are the result of lingering effects of her health problems, a Clinton aide confirms.

"She'll be wearing these glasses instead of her contacts for a period of time because of lingering issues stemming from her concussion," said spokesman Philippe Reines. "With them on she sees just fine."

Several points need to be made in connection with this.  If a known liar with an incredible incentive to lie on the particular occasion says of her leg being in a cast that it all began with a stomach virus which led to a fall, we might believe her, but we’d certainly take context into account. 

The next point is key.  Concussions only rarely cause blood clots.  Here is WebMD:

A concussion may lead to thinking, sleeping, and balance problems, and symptoms. In rare cases, a blood clot may form on the brain after a concussion. This is a life-threatening condition.

To this we must add that if, in spite of the rarity of the concussion to blood clot transition, that is nonetheless what really happened, we would still be well within the bounds of reason to inquire what caused the concussion in the first place, and whether it was due to syncope (fainting) brought on by dehydration. 

Maybe it was what happened, but notice that in addition to overlooking the probability issue accepting Clinton’s lie-incentivized version of events requires us to accept that she had a concussion in the first place.

Also, even if she did suffer a concussion, we must observe that those can easily be brought about by falls subsequent to strokes--and, unlike concussions not preceded by strokes, strokes, and therefore quite reasonably concussions followed by strokes, frequently, not infrequently, are accompanied with blood clots in the brain.  Indeed, embolic strokes are not merely associated with blood clots in the brain; they are constituted by blood clots in the brain (click preceding link). 

It is also incontrovertibly true that Clinton, in her role as Secretary of State, travelled 956,733 miles -- most of it in the air.  It is just as clear that frequent and long flying can raise the risk of strokes (especially in the elderly; click here and here). Clinton was a very, very frequent, very, very long flyer was she not? And she’s no spring chicken. 

Then there are the glasses Clinton was wearing.  What kind of glasses were they?  Again, ABC:

Reines did not specify what type of lens the secretary was wearing, but medical experts say a fresnel prism is common in cases like these. Fresnel prisms usually come in the form of a piece of thin, transparent plastic that can be adhered to existing lenses. The special grooves in these prisms change the way light enters the eye, making them useful in treating double vision.

So medical experts think the spectacles had lenses of the Fresnel species.

The thing is, Fresnel lenses are indeed frequently prescribed subsequent to concussions (and please keep in mind the previous point about strokes sometimes causing concussions), but they also frequently prescribed to stroke patients.

To be sure, nothing in this purports to prove that Clinton suffered a stroke; the point is simply to indicate the reasons why it is quite reasonable to suppose she might have.  Information as to the relative incidence rates of non-stroke derived concussions in the elderly and strokes in the elderly could in principle be used to derive a probabilistic estimate of the stroke likelihood

Even in lieu of such estimates, we can confidently suggest this: the incident rate of non-stroke generated concussions would have to be quite a bit higher than strokes that produce brain blood clots in order to justify the belief that Clinton’s brain blood clot was brought on by a non-stroke produced concussion.  This is because, as has already been observed above, the link between concussions and brain clots is statistically weak.

Dr. Jason Kissner is associate professor of criminology at California State University, Fresno.  You can reach him at crimprof2010@hotmail.com.