Secretary of State Hillary Clinton continued treatment for a blood clot in a vein that runs between her brain and skull, complicating health problems that have kept the top U.S. diplomat out of public view for more than three weeks.
Clinton's hospitalization in New York City on Dec. 30 fueled concerns about the health of the former first lady and U.S. senator from New York who among Democrats has been mentioned as a potential 2016 presidential candidate. In a Gallup poll of Americans released over the weekend, she ranked as the most admired woman in the world for the 11th year in a row.
"In the course of a routine follow-up MRI on Sunday, the scan revealed that a right transverse sinus venous thrombosis had formed," her doctors said, describing that as a clot in a vein found in the space between the brain and the skull behind the right ear.
David Langer, a neurosurgeon who isn't involved in Clinton's care, said in an interview that the "prognosis is quite good" when such a blockage is caught early. This rare type of clot may be due to Clinton's dehydration, which her spokesmen said happened during a recent stomach virus, and also can occur in cancer patients, said Langer, director of cerebrovascular research at North Shore University Hospital in Manhasset.
"It's really good news that it didn't result in a stroke, said Gholam Motamedi, a neurologist at Medstar Georgetown University Hospital in Washington, who also isn't involved in Clinton's care.
Her doctors said in the statement that they are working to dissolve the clot with blood thinners and that Clinton will be released from New York-Presbyterian Hospital once the proper medication dose has been established.
"In all other aspects of her recovery, the secretary is making excellent progress and we are confident she will make a full recovery," Bardack and El-Bayoumi said. "She is in good spirits, engaging with her doctors, her family, and her staff."
Clinton, 65, has been in the hospital for observation of the blood clot. Officials said she sustained a concussion in a fall while sick with the stomach virus.
The doctors not involved in the case raised questions about whether there may be a serious underlying cause of the clot, such as cancer, and said further blockages could be potentially dangerous.
A concussion isn't known to increase the risk of this type of blood clot and a magnetic resonance imaging, or MRI, scan isn't standard procedure to look for one, Motamedi said in a telephone interview. Blood thinners are used to make sure such a clot doesn't get any bigger and cut off the brain's blood flow or cause further damage, he said.
"It's important to look into the possible underlying causes," he said. "If you find them, you have to focus on treating the underlying cause as well as prevent a recurrence." The condition isn't common, and "I hope there is no underlying malignancy or serious problems," he said.
"Ultimately, it's not the concussion that caused this," Langer said in an interview. "It's unclear what the circumstances were surrounding her fall. Usually a skull fracture is associated with it. No one has mentioned that. I don't want to say she had one."
Allen Taylor, chief of cardiology at Medstar Georgetown University Hospital, said he wondered if the clot "wasn't the original problem -- that she fell related to this problem and then never really had a concussion. This is far more complex and a little less clear-cut as to the cause."
The outside doctors said they see no reason at present to think this health scare will hinder Clinton in the future.
"This shouldn't affect her ability to serve our country or do whatever she wants to do in four years, as long as she is well managed" medically, Langer said.
Clinton, who owns a home in Chappaqua, said months ago she wouldn't continue in her post during a second term for President Barack Obama, and he announced Dec. 21 that he will nominate Sen. John Kerry, a Massachusetts Democrat, to succeed her. Clinton's aides have disclosed scant details about her initial illness and the subsequent complications.
"Her situation has remarkable, complex implications for politics and business around the world, and the process of government in the United States," said Scott Sobel, president of Media & Communications Strategies based in Washington. "Her immediate and long-term condition is really important for a number of stakeholders, even -- and it's a very, very long list -- of other countries."
An administration official who has been monitoring Clinton's progress said that at no point has she been incapacitated. The period when Clinton was least able to work was when she had the stomach virus, according to the official, who asked not to be identified discussing her health.
Clinton has experienced a blood clot before. In 1998, while she was first lady, she had "the most significant health scare I've ever had," she told the New York Daily News in an October 2007 interview. She recalled suffering what the newspaper described as "terrible pain" behind her right knee.
She thought she simply needed rest until a White House doctor told her to rush to Bethesda Naval Hospital, in nearby Bethesda, Md., where doctors diagnosed a large blood clot behind her right knee.
The absence of detailed information on her current condition until the latest report from Clinton's physicians left an information vacuum.
Speculation filled media from the Daily Beast website to the tabloid National Enquirer, whose cover screamed "Hillary Clinton Brain Cancer Drama!" Assistant Secretary of State Philippe Reines called the Enquirer report "absolute nonsense." Seven Statements The administration official said Clinton's media team has tried to be forthright, issuing seven statements in the three- and-a-half weeks she has been ill, every time there has been a shift in her condition. The continued questions might be driven in part by the intense public and media interest in Clinton and her husband, former President Bill Clinton, the official said.
In an interview, crisis-management specialist Jamie Moss said Clinton's team could have quelled rumors more effectively by having an attending physician issue a statement on her condition, as the State Department did Monday.
"It's also important to consider even though she's a major public figure with major public obligations, at the same time she's a private citizen and should be afforded the same rights of privacy of any citizen," said Moss, founder and president of newsPRos, a national media relations and crisis-management firm based in New York.
Crisis management experts such as Sobel and Jim Moorhead, co-chairman of the crisis-management practice at the law firm Steptoe & Johnson LLP in Washington, found no fault in the way Clinton's team has responded.
"Hillary Clinton may have a health crisis, but right now she doesn't have a communications crisis," Moorhead said in a telephone interview before the latest statement. "The balance for any public official in addressing health issues is to be a timely source of accurate information. So far, I think that has occurred."
Clarence Jones, author of "Winning with the News Media: A Self-Defense Manual When You're the Story," said his advice to clients is to "tell them everything because otherwise there will be a lot of speculation" that the situation is worse than it is.
"My attitude about any media relations is that you need to tell them everything because they will eventually find out, particularly if there's a lot of media focus on a person or an event," he said in a telephone interview from Holmes Beach, Fla.