Spanish newspapers published the leaked text of the Pinochet medical report on 16 February.

The conclusions of the medical report, obtained and translated by ABC, state the following:

Senator Pinochet has a complex medical history, but the main medical problems at present are peripheral diabetic neuropathy and a recent progressive cerebrovascular lesion.

The diabetic neuropathy adds to his difficulties in walking and a noted tendency to postural hypotension.

The diabetes, along with his smoking in the past, will also have made damage to the arteries likely.

The cerebrovascular process has manifested itself in minor brain haemorrages and temporary ischemic periods, but they are also the cause of progressive damage without acute symptoms.

There is clinical evidence of extensive brain damage, including bilateral lesions to the pyramidal tracts, which cause spasms and affect the base ganglions, producing periods of Parkinson's Disease.

The presence of primary reflexes indicates that lesions have occurred to the frontal lobes, and the lack of memory is compatible with bilateral damage to the structures of the temporal lobes.

The difficulties in the ability to comprehend are the result of the lack of memory. While many of the lesions can be attributed to areas of the brain irrigated by the basilar artery (which, as the brain scanner shows, is calcified), the damage to the frontal lobes indicates a more generalized arterial lesion.

Trial attendance

Physically: Senator Pinochet would at the moment be able to attend a trial, but as the periods of cerebrovascular lesions have progressed despite the excellent treatment (with correct controls of diabetes and arterial pressure and with anti-coagulant agents) a progressive deterioration of both his physical and mental condition is likely.

Mentally: In our opinion, Senator Pinochet is not at the moment mentally capable of taking part in a trial with full knowledge of the facts. We base this opinion on:

• Lack of memory both of recent and distant events.
• Limited ability to understand complex sentences and questions, due to loss of memory and, consequently, inability to adequately process verbal information.
• Loss of his ability to express himself in an audible, succinct and relevant way.
• Periods of fatigue.

With these impediments he would be incapable of sufficiently following the process of a trial so as to instruct his lawyers.

He would have difficulty responding to the content and the implications of the questions asked of him, and he would not be aware of this difficulty.

His memory of distant events is diminished. He would have difficulty making himself heard and understood in his answers to questions.

We are convinced that the inabilities diagnosed are due to brain damage, as they are in their nature compatible with, and correspond to that phenomenon, and the formal neuropsychological tests did not show any of the signs of deliberate exaggeration of damage.

To be precise, those neuropsychological tests indicative of original intelligence and of level of education (like the WAIS vocabulary scale) indicate above-average ability.

No depression

At the moment, Senator Pinochet does not show any signs of clinical depression.

Situational stress, as a trial is likely to produce, causes psychological responses which could accelerate the development of vascular lesions.

We are told, however, that in the past Senator Pinochet has shown a notable ability to contain stress.

We are therefore unable to give any useful opinion on the possible effects on his health if he faces a trial. Most of the cases of lesions seem to have occurred in a series of tromboembolic episodes during September and October 1999.

Sufficient time has passed for most of the spontaneous recovery which might be expected after these episodes to have occurred.

Although it is characteristic of lesions due to cerebrovascular processes for daily fluctuations in functional capacities to occur, we consider a sustained and significant improvement of the latter to be unlikely.

Signed by John Grimley Evans, Michel J Denham and Andrew J Lees on 6 January.