Clinton’s ‘blood clot’ – an MRI and media challenge.

So it turns out that Hillary Clinton, US Secretary of State – who has visited more countries in office than any other – developed a right transverse sinus venous thrombosis.

http://www.state.gov/r/pa/prs/ps/2012/12/202419.htm

Previously it was just called a ‘blood clot’ requiring ‘hospital’ and ‘blood thinners’. This followed a day of intense speculation in the media which included thousands of webpages, social media messages and, presumably many hours of broadcast TV and radio, talking over where the ‘blood clot’ was. If it were a DVT then why should she spend so much time in hospital? Some more unusual type of ‘blood clot’ was obviously the cause but no details were being released.

She had a routine MRI scan following ‘concussion’ and her doctors were keen to point out that “It did not result in a stroke, or neurological damage”.

For a potential future presidential candidate this must have caused quite a challenge. You need to quickly let people know that your health is assured and you are being cared for but telling the public that you have a clot near your brain is not what they may want to here. Transparency is important but communicating unusual medical conditions can be difficult.

Now everyone will be an expert in transverse sinus venous thrombosis.

  • djnicholl

    The original blood clot following a minor concussion was always a bit odd, but it now appears this was (likely) to buy the medical team time to establish the correct diagnosis as the choice of imaging can be crucial http://www.ncbi.nlm.nih.gov/pubmed/23253278

    I suspect the concussion was a red herring (or at least that was the story given to the media) while they hurriedly tried to determine a neuroradiology opinion (not least as one can find congenital variations in venous drainage which can mimic venous sinus thrombosis, so the clinical story needs to fit.

    Thus the reports that she was in fact “severely dehydrated” http://www.guardian.co.uk/world/2012/dec/31/hillary-clinton-doctors-clot-brain are probably more important than the history of concussion.

    What this case shows is:
    1) The importance of getting the diagnosis right
    2) Sometimes buying some time in a celebrity patient with a vague story initially while the correct tests are arranged.
    3)The importance of taking an accurate clinical history and examination findings as these must drive the correct choice of imaging (see case 3 in our recent paper- a patient with a cerebral venous sinus thrombosis that came on in a dehydrated patient, missed on a non-contrast CT head scan http://www.rcpe.ac.uk/journal/issue/journal_42_4/nicholl.pdf

    Of course, all of this is speculation, we will only know the details (and MRI results) if she runs for President in 2016. US Presidential candidates have a habit of publishing all their medical records in the run-up to elections. So much for confidentiality. 

    [David Owen’s book “In sickness and power” is a great read if interested in background of medical problems in political leaders. http://www.amazon.co.uk/In-Sickness-Power-Illness-Government/dp/0413777081/ref=sr_1_2?ie=UTF8&qid=1357045018&sr=8-2%5D