Excellent, informed analysis. Thank you.
I would posit one other thought. It is very possible, even probable that some of things we “know” aren’t so which could/would be misleading. Perhaps she is not taking Coumadin. Perhaps she didn’t have a concussion in 2012 and had a stroke. Perhaps her event in 2012 was recovery from the surgery you perform to stop the Parkinsons tremors.
You are by far and away more informed on these matters than I, but we are talking about a congenital liar. I agree there is something neurological, cardio or cerebral vascular going on with her and she is trying desperately to hide it. If she has pneumonia it is a side effect, not a primary diagnosis.
If she had surgery for tremor it would leave bilateral thalamic lesions which on an MRI would appear to be symmetrical subcritical “lacunar” infarcts. If it were done with a gamma knife there would not even be Parietal burr holes in the skull. There may be some small evidence of frame placement on the skull but even that may be difficult to detect. Over time, even the thalamic “infarcts” would resolve to very small lesions. Four years later, or so, it might be hard to detect surgery for Parkinson’s in a patient determined to conceal it.
In my residency training in the 80s I had to do 6 months of neurology. I recall one patient who had “maxed out” on the drugs. Max doses of L dopa and cogentin and he was still rigid as a board and immobile. You could passively “break” his rigidity and range an elbow and try to “tune” his cogwheel ing but he was bed ridden and immobile. I had the nurses start getting him out to a chair for several hours a day. He was “in there” aware of everything. He was there when I got there and he was there when I left.
I just can not imagine someone having a tremor so bad they got surgery several years ago being able to be “tweaked” up to the levels of performance we have seen from her yet still be so advanced as to have an event like the one on Sunday. There is either a piece missing or something we “know” is wrong. I don’t know what it is but to say we just don’t have enough data.