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The Independent, 17.2.00

Doctors support stroke claim, but leave questions. Dr Fred Kavalier

The medical specialists who examined General Pinochet paint a picture of an elderly man with diabetes who is suffering from the effects of a number of small strokes. These have caused damage to different areas of the brain, including the parts of the brain that contribute to both short-term and long-term memory. Some of these strokes seem to have caused permanent damage, while others - the transient ischaemic attacks - will have only caused temporary effects lasting less than 24 hours.

When they examined the general, the specialists found evidence that convinced them his brain damage was genuine. His reflexes, for example, were found to be unusually exaggerated, and this is something that he would be highly unlikely to able to feign. Similarly, they found evidence of some unusual reflexes that would not occur except in the presence of specific brain damage.

He also showed some symptoms suggestive of damage to areas of the brain that are affected by Parkinson's disease. This does not mean that he has Parkinson's disease, but that these mini-strokes have caused some symptoms similar to the disease.

The specialists had access to some sort of scan, although it is not clear from the leaked summary whether it was a CAT or MRI scan, which would provide more evidence of brain damage. But even a highly sophisticated scan would not be able to answer the question of whether he was able to participate in a trial.

This type of widespread brain damage is likely to have been made worse by the general's diabetes. Diabetes affects small blood vessels throughout the body and makes strokes more likely. The specialists comment that diabetes has also affected his blood pressure control mechanisms, although this is unlikely to interfere with his mental capacity.

It is particularly interesting to note that the doctors - two specialists in geriatrics, and a neurologist - failed to find any evidence of clinical depression. There has been recent press speculation that he was suffering from severe depression, but this seems not to have been the case at the time of his examination.

The experts conclude that "physically" General Pinochet would be able to face a trial. "Mentally", however, they feel that he is not fit enough to participate fully in a trial. This is based partially on the assumption that his physical and mental faculties will continue to deteriorate. While this may well be true, it is an assumption that can only be tested as time passes. It is notoriously difficult to predict the speed at which such patients will deteriorate.

It is not clear whether the specialists examined the general only once, or if they saw him on more than one occasion - even though a local GP did see him several times. The evidence that he is unfit for trial would be stronger if it was based on repeated examinations. 

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