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Doctors find neurological damage to Americans who served in Cuba

The U.S. Embassy in Havana. (Alexandre Meneghini/Reuters)

Diplomats serving at the U.S. Embassy in Cuba “appeared to have sustained injury to widespread brain networks” there, according to physicians who evaluated them for the State Department.

But the physicians could find no definitive cause for their ailments, they said in an article in Thursday’s edition of the Journal of the American Medical Association (JAMA).

The article, written by specialists at the University of Pennsylvania’s Perelman School of Medicine, provided the most detailed description to date of the injuries — including headaches, dizziness and hearing, vision, sleep and mood disorders. The specialists examined 21 of 24 diplomats who reported symptoms between late 2016 and August 2017.

The State Department has charged that its personnel were targeted for specific “attacks” while in Cuba. Late last year, the Trump administration ordered the withdrawal of more than half of the embassy’s diplomats and their families from Havana and advised Americans not to travel there. A similar number of Cuban diplomats were expelled from their embassy in Washington.

When asked about the attacks on U.S. diplomats in Cuba, Secretary of State Rex Tillerson said Dec. 6 he had told the Cuban government "you can stop it." (Video: The Washington Post)

Controversy over the medical issues coincided with President Trump’s implementation of policy changes reversing parts of the Obama administration’s normalization of relations with Cuba in 2015. The new rules, fulfilling a Trump campaign promise to roll back what he called a “terrible” policy, imposed new restrictions on trade and travel to Cuba.

Cuban officials have repeatedly denied responsibility for any attacks on the diplomats and have said the United States has provided little substantive information for them to investigate the complaints.

Some U.S. officials have speculated that the “attacks” could have been conducted by “rogue” elements within the Cuban government or military, or by agents of an unidentified third country.

The clinicians examined 11 women and 10 men, with an average age of 43, whose evaluations began an average of 203 days after they first noticed symptoms, the article said.

In most cases, the affected diplomats reported hearing a loud, painful noise that they later associated with their symptoms. “For 18 of the 21 individuals,” the JAMA article said, “there were reports of hearing a novel, localized sound at the onset of symptoms in their homes and hotel rooms” in Havana. “Affected individuals described the sounds as directional, intensely loud, and with pure and sustained tonality,” although some described it as high pitched, and others said it was low pitched.

“The sounds were often associated with pressurelike or vibratory sensory stimuli . . . likened to air ‘baffling’ inside a moving car with windows partially rolled down,” the report said. Some, it said, were awakened by the sound, which was variously said to have lasted seconds or longer than 30 minutes. Some reported immediate neurological symptoms, while others noticed nothing until days or weeks afterward.

But, the JAMA authors noted, as have numerous other experts, that “sound in the audible range . . . is not known to cause persistent injury to the central nervous system” and concluded that “it is currently unclear if or how the noise is related to the reported symptoms.”

While not completely excluded, possible infections or other group medical causes were “not readily apparent,” it said. At the same time, “it is unlikely that a chemical agent could produce these neurological manifestations in the absence of other organ involvement, particularly given that some individuals developed symptoms within 24 hours of arriving in Havana.”

While many of the symptoms were similar to those experienced with a concussion, there was no evidence of physical trauma, and MRI examinations showed no significant brain abnormalities.

But to the extent the physicians were able to determine, many of the reported problems were borne out by neurological, hearing and vision evaluations.

“Neurological examination and cognitive screens did not reveal evidence of malingering, and objective testing and behavioral observations during cognitive testing indicated high levels of effort and motivation,” the JAMA article said in raising the issue of possible “collective delusional disorders.”

“Several of the objective manifestations consistently found in this cohort,” including vision and balance abnormalities, “could not have been consciously or unconsciously manipulated,” it said.

When it received initial reports about “sonic” stimuli and hearing problems, the State Department set up a triage system at the University of Miami that evaluated 80 members of the embassy community, the article said. The University of Pennsylvania’s Center for Brain Injury and Repair was then asked to investigate 16 people — later totaling 21 — found to have concussion-like symptoms.

An accompanying JAMA editorial cautioned that “several important considerations should guide interpretation” of the data, including the variability of reported symptoms among the patients and the lack of precision of some of the information with which clinicians were provided.

The editorial also noted that “several of the abnormalities . . . (e.g. eye movement and balance dysfunction) were based on patient self-report or involved at least some degree of subjective interpretation” by examiners.

“Before reaching any definitive conclusions, additional evidence must be obtained and rigorously and objectively evaluated,” the editorial concluded.