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The Independent, 16.2.00

Details of Pinochet medical report.

The medical report on General Augusto Pinochet - translated back into English from extracts published in two Spanish newspapers:

Main report

Previous Medical History according to reports made available:
1. Asthma, diagnosed in 1980.
2. Diabetes melitus type 2, diagnosed in 1990.
3. Diabetic neuropathy. Studies of neuropathic behaviour showed combined sensorial and motor nueropathy, light in character, of axonal type, affecting principally his lower extremities. No retinopathy was observed. Good control of diabetes.
4. Defective cardiac performance identified in 1992 when a apacemaker was installed.
5. Hyperthyroidism caused by amiodarona.
6. Arthritis in left knee. Operated in 1996.
7. Multinodal neck tumour.
8. Previous attacks of gout.
9. Permanent atopic rinitis.
10. Previous operation to left groin hernia.
11. Deafness due to accoustic trauma.
12. Decompression of the lumber region of the vertebral column due to estenosis of the column and prolapse of several vetebrae in October 1998. Postoperative ulcers caused by isquial pressure.
13. Passin isquemic attacks in June 1997 and September 1999.
14. Symptoms of enlarged prostate that worsened between 27 June 1999 and 5 October 1999.
15. Characteristic symptoms of Parkinson's disease.
16. Lapses of memory.

Recent medical history

After the surgical decompression of the lumbar region of the spinal column in 1998, senator Pinochet suffered serious headaches for several weeks that cleared up spontaneously. In the last eight or nine months he has had difficulty in walking and now can barely cover 200 metres without his legs weakening so that he cannot continue. He walks with the aid of a stick. Loss of sensation in the soles of his feet also increased during this time.

In the last 10 months, memory problems gradually worsened, and recently accentuated to a notable extent. He has difficulty in remembering names, dates and remote events. We are informed that he speaks as if he has difficulty in converting ideas into speech.

On 9 September 1999, senator Pinochet was walking in the garden and he suddenly had a severe headache and lost his balance. Other episodes of which we have been informed, which appear to indicate some transitory cerebral malfunction, include the impossibility, on one occasion, of recognising his wife and the impossibility, on another, of realising that his son had visited him. He remembers an episode in which his vision became clouded for a short time.

When visited by Doctor Thomas on 14 September, senator Pinochet showed nominal circumlocution and disphasia, together with an observable frontal tremor, inexpressive face, poor reflexes and strong jaw spasms. He walked with tiny steps, with instability in turning round. Neuromotor weakness was noticed in his upper left side, worse in the leg than in the arm, along with memory lapses. The diagnosis was of multiple small bilateral cerebral attacks.

When he was subsequently examined by Dr Thomas, a new deterioration with new isquemic cerebral attacks on 20 September and 9 October was observed. A clear increase in traces of symptoms of Parkinson's disease was noted, with the typical difficulty of expression, deterioration in writing ability, inability to dress unaided and the need for help in getting up from a chair and moving from one place to another.

Since then the senator has suffered two new falls, one in the garden and the other in the bathroom, both due to a loss of balance without losing consciousness. His voice has deteriorated since October.

There is a history of urinary symptoms - vacillation, weak flow, and on occasions slight incontinence. In general he can stay in bed until early morning, but then has to evacuate three or four times.

Senator Pinochet was depressed last summer but this has ceased to be a problem. He still misses his native land, and feels bored and frustrated by his physical ailments. He wakes frequently in the night. In recent months he has lost interest in reading, says he has forgotten how to use the computer and has to sit immediately in front of the television. Writing letter has become something of a routine, and his writing is less legible. Recently he has developed a certain difficulty in shaving without cutting himself.

His appetite is normal and his weight constant. In the last few months he has experienced painful discomfort in both buttocks and the cold weather has affected his knees.

Senator Pinochet arrived in a wheelchair and was interviewed in bed. He is severely deaf, but is able to hold a conversation with a hearing aid. He was alert and cooperative, but easily tired. His voice was low and monotonous. His tone was neutral.

Cardiovascular system. Regular pulse of 65 (pacemaker in place). No oedema, normal jugular vein pulse. Heartbeat normal. No blow (golpe) in the carotid or abdominal. Blood pressure 135/70 lying down and standing up on one occasion. 130/60 lying down passing to 110/70 on another occasion (associated with some instability)

Chest: Pacemaker in place. No other anomaly detected.

Abdomen: Obese, normal, no soft areas. Liver, spleen, kidneys and bladder not palpable. No abnormal mass.

Cerebral activity: Shows slowness and difficulty in comprehending complex instructions.

State of Mind: Agreeable and cooperative. Face immobile but smiled appropriately. Sense of humour intact. No evidence of depression.

Locomotion: Needed help to get out of bed and in keeping steady once standing up. Walking with tiny steps with a stick in his right hand and no movement at all in in the left arm. Tendency to lean backwards. Turns without too much difficulty.

Writing: tendency to micrography.

Pinochet's Medicines

Budesonida 400mg, a diuretic, twice a day. Metformina 500mg, oral anti-diabetic, three times a day. Finasteride 5mg, for prostate hypertophy, daily. Nimidipina 30mg, coronary vasodilator, daily. Allopurinol 150mg, uric acid regulator, daily. Amiodarona 200mg, anti-arrhythmic, daily. Thyroxina 75mg, hyperthyroidism, daily. Terzosin 2.5mg, prostate hypertophy, daily. Citalopram 30mg antidepressant, daily. Clopidogrel 75mg anticoagulant (antiplaquetario), daily. Terbutalina (inhalor), for asthma, daily.

General conclusions

Senator Pinochet has a complex medical history but the main medical problems at present are peripheral diabetic neuropathy and a recent progressive cerebrovascular damage. The diabetic neurpathy contributes to difficulties in walking and a detecteble tendency to postural hypertension. The diabetes would also have tended towards arterial damage, as would his past as a smoker.

The cerebrovascular ailments manifested themselves partly in the form of minor brain hemorrhages and momentary isquemic attacks, but they have also caused a progressive deterioration lacking in acute symptons. There is clinical evidence that the damage extends throughout the brain. This includes damage to the piramidal tracts, causing spasticity in the basal ganglions, producing occasional symptoms of Parkinson's disease.

The presence of primary reflexes indicates that lesions to the frontal lobes, and the loss of memory is attributable to bilateral damage in the structure of the temporal lobes. Difficulties in the ability to comprehend are a seconday effect of memory loss. While many of the ailments may be attributed to areas of the brain supplied by the basilar artery (which shows signs of calcification according to the brain scan) the damage to the frontal lobes indicates more generalised arterial illness.

Capacity to face Trial

Physically. Senator Pinochet would be able at the present moment to face trial, but as the effects of cerebrovascular deterioration have increased, despite the best possible treatment (with good control of diabetes, arterial tension and the use of anticoagulants) it is probable that his physical and mental faculties will continue to deteriorate.

Mentally. It is our opinion that senator Pinochet is not at present in a fit state to partipate fully in a trial. We base this opinion on:
1. Memory lapses that he shows for both recent and long-term events.
2. Limited comprehension of complex sentences or questions, because of diminished memory, and consequent inability to process verbal information adequately.
3. Diminished ability of expressing himself in an audible, comprehensible and coherent form.
4. Tendency to fatigue.

With these handicaps he would be unable to follow the proceedings of a trial sufficiently to instruct his lawyers. He would have difficulty in responding to the content and meaning of questions put to him and he would be unaware of this difficulty. His memory of events in the distant past is diminished. He would have difficulties making himself heard and understood when answering questions.

We are persuaded that the deficiencies diagnosed are due to cerebral damage, since they are compatible with symptoms of that illness and are consistent in their manifestations. Neuropsychological tests do not show any signs of deliberate exaggeration of the ailments. Concretely, the neuropsychological tests indicative of original intelligence and educational level (like the WAIS vocabulary scale) show high ability. At the moment, Senator Pinochet shows no signs of clinical depression.

Prognosis

The stress occasioned by his situation and which a trial would would probably cause, provokes physiological reactions that could accelerate the progress of vascular deterioration. We are informed, however, that Senator Pinochet has in the past shown a remarkable ability to overcome stress. Therefore we feel unable to offer a conclusive opinion on the possible effects of a trial upon his health. The main damage seems to have occurred during a series of thromboembolic episodes in September and October 1999. Sufficient time has elapsed for any spontaneous recovery to have occurred. Although some sporadic fluctuations in functional abilities are characteristic of brain damage caused by cerebrovascular ailments, we consider it unlikely that substantial sustained functional improvement will occur.

Signed

John Grimley Evans, Michael Denham and Andrew Lees, 6 January 2000

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