Pinochets Medical Report Essays - RTT, Augusto Pinochet,

Pinochets 'Medical Report' pinochets 'medical report' Senator Pinochet has a complex medical history, but the main active medical problems at present are diabetic peripheral neuropathy and recently progressive cerebrovascular brain damage. The diabetic neuropathology is contributing to difficulties in walking and to the observed tendency to postural hypertension. The diabetes will also have predisposed to arterial disease as will a past history of smoking The cerebrovascular disease has manifested partly as minor strokes and transient asthmatic attacks but also causes progressive damage without acute symptoms. There is clinical evidence of extensive damage to the brain. This includes bilateral damage to pyramidal tracts to cause spasticity symptoms and to the basal ganglia producing features of parkinsonism. The presence of primitive reflexes indicates damage to the frontal lobes and the memory defecit is comparable with bilateral damage to temporal lobe structures. Difficulties in comprehension are secondary to the memory deficit. While much of the damage is attributable to areas of the brain served by the basilar artery (shown to be calcified, in the CT scans) the frontal lobe impairment indicates more generalised arterial disease. Fitness for trial Physically: Senator Pinochet would at present be able to attend a trial but as features of cerebrovascular damage have progressed despite optimal treatment (with good control of diabetes and blood pressure and antiplaseler agents) further deterioration in both physical and mental condition is likely. Mentally: It is our view that Senator Pinochet would not at the present be mentally capable of meaningful participation in a trial. We base this opinion on: 1. Memory defecit for both recent and remote events. 2. Limited ability to understand complex sentences and questions owing to memory impairment and consequent inability to process verbal information appropriately. 3. Impaired ability to express himself audibly, succinctly and relevantly. 4. Easy fatiguability With these impediments he would be unable to follow the progress of a trial sufficiently to instruct counsel. He would have difficulty in understanding the content and implications of questions put to him and would have inadequate insight into his difficulty. His memory of remote events is impaired. He would have difficulty making himself heard and understood in replying to questions. We are satisfied that the impediments we have identified are due to brain damage, as they are coherent in nature and consistent in manifestation and formal neuropsychological testing showed none of the features of deliberate exaggeration of impairment. In particular those neuropsychological tests indicative of original intelligence and educational levels (such as the vocabulary scale of the WAIS)show superior performance. At present, Senator Pinochet shows no evidence of clinical depression. Situational stress, as likely to be occasioned by trial, produces physiological responses that could accelerate the progression of vascular disease. We were told, however, that Senator Pinochet has in the past shown notable personal abilities in managing stress. We therefore do not feel able to express any useful opinion on the possible effects on his health of undergoing trial. The major episodes of damage seem to have occurred in a cluster of thromboembolic events during September and October 1999. There has been sufficient time for the great majority of any expected spontaneous recovery from these events to have taken place. Although some day to day fluctuation in functional abilities is characteristic of brain damage due to cerebrovascular disease we consider further sustained functional improvement of a significant degree unlikely. Background - the rest of the report: Professor Sir John Grimley Evans, Dr M J Denham, and Professor Andrew Lees undertook a clinical consultation with Senator Pinochet at Norwick Park Hospital on January 25th 2000. The consultation was undertaken in Spanish. Also present: Dr Henry Olivi (Observer) Prof. D J Thomas (Observer) Nurse Shelley Cape, Manuel Cerda (Senator Pinochet's valet) Recent Medical History: Following surgical decompression of lumber spine in 1998 Senator Pinochet was troubled for some weeks by severe headache across the brow. This resolved spontaneously. For the last 8 to 9 months he has noted difficulty in walking and now can only cover 200 yards before his legs become too weak to continue. He now walks with a stick. Numbness of the soles of his feet has also progressed over that time. Over the last ten months he has noticed a gradual