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This Year's Historical Clinicopathological Conference (CPC) Examines the Death of Revolutionary Russian Leader Vladimir Lenin

Friday, May 04, 2012

 Lenin was only 54 when he died and had few of the risk factors associated with the strokes that killed him.

Vladimir Ilyich Lenin, who died at only 54 years old in 1924, is remembered as one of the most seminal political figures of the 20th century. The cause of his last difficult years of severe health problems has been debated ever since – did Lenin, the founder and first head of the Soviet Union, suffer from syphilis? What caused the massive stroke that killed him just as the Communist nation he envisioned was taking shape?

Now, 23 years after the Soviet Union fell, doctors are using modern medical knowledge and techniques to examine the medical mystery behind this political figure’s suffering and eventual death. Lenin is the subject of this year’s annual Historical Clinicopathological Conference (CPC) sponsored by the University of Maryland School of Medicine and the Veterans Affairs (VA) Maryland Health Care System. The conference, which will be held this year at 1:30pm on Friday, May 4 in Davidge Hall, is devoted to the modern medical diagnosis of disorders that affected prominent historical figures.

The physician considering Lenin’s case is noted neurologist and neuropathologist Harry Vinters, MD, professor of neurology and neuropathology and chief of the division of neuropathology in the David Geffen School of Medicine at the University of California, Los Angeles. Each year at the conference, a medical expert is joined by a historian who summarizes the life and historical impact of the figure in question. This year’s guest speaker is Lev Lurie, PhD, a St. Petersburg-based expert in Russian history and politics.

Dr. Vinters said he was particularly taken with his subject, as he has personal ties to the history of the Soviet Union. “My grandparents were refugees from the Baltic states,” he explains. “They came to America as refugees from Latvia when the Soviet Union invaded. I found this case especially interesting, given that Lenin and his successors are directly responsible for my being born in North America rather than in the Soviet Republic.”

He began his work by considering Lenin’s clinical history and autopsy report, the latter translated from the original Russian. In the report, Dr. Vinters found evidence of at least two strokes — a major stroke on the left side of his brain that would have left him unable to speak and paralyzed on one side of his body, and a smaller stroke on the right. It is likely, the doctor says, that Lenin suffered the effects of this larger stroke for some time before dying. Indeed, according to the historian, Dr. Lurie, history shows that Lenin’s health began to decline in late 1921. The Communists had won the Civil War, but turmoil was still abundant. Lenin began to suffer from chronic headaches, insomnia and fainting spells. “Doctors failed to discover anything but overwork,” says Dr. Lurie. “The patient was prescribed rest that didn’t bring him any relief.”

Over time, his condition worsened. In November 1921, Lenin faltered during a major speech, forgetting the words and snapping his fingers as he tried to remember. “Later on, aphasia — the inability to speak — and agraphia — the inability to write — continued to develop, at times slightly lessening,” explains Dr. Lurie. "But finally they took their course. He could hardly walk. His right side was paralyzed. He had to learn to speak anew and to write with his left hand. He suffered in his estate before dying on January 24, 1924.”

“What happened to Lenin is not a mystery,” Dr. Vinters says. “The autopsy findings and history are classic of stroke. But our question is, what was the cause of those strokes in a relatively young and otherwise healthy man?”

Lenin is somewhat of a puzzle, he explains. It is evident that the basal vessels in his brain were extremely hardened — this hardening of the blood vessels is known as atherosclerosis — but Lenin did not have many of the classic risk factors for this condition. “The interesting thing is why he would develop atherosclerosis at such an early age,” Dr. Vinters says.

Lenin was not a smoker, a leading risk factor for atherosclerosis. In fact, he abhorred the habit and forbade smoking in his presence, a rarity considering how common smoking was among Russians during his lifetime. His autopsy also showed no signs of high blood pressure, another major risk factor. High blood pressure often causes an enlarged heart or kidney damage, neither of which were reported in Lenin’s body. He was not elderly, did not suffer from diabetes and was not obese — all also significant risk factors for atherosclerosis.

Dr. Vinters notes, however, Lenin’s family history. His father died at 54 — the identical age as Lenin himself. “This family history is ominous,” the doctor says. “He may have had a very strong predisposition to atherosclerosis.”

Stress is another risk factor, and there is no question Lenin dealt with it. “He led an extremely stressful life,” says Dr. Vinters. “People were always trying to assassinate him, for example. We all know what stress is, but everyone reacts to it differently. It is not clear how it affected him.”

The specific cause of his cerebrovascular disease is still unclear, Dr. Vinters says, though the long-discussed possibility of syphilis is ruled out by the autopsy report. “Syphilis was quite common in those days and was hard to treat,” the doctor explains. “Meningovascular syphilis has distinct characteristics in the brain. The infarcts, or strokes, are usually very small in syphilis. I didn’t see evidence of that. The other vessel that is usually affected by syphilis is the aorta, and that characteristic is not described in the autopsy, either. It is very unlikely that he would have had syphilis.”

Strokes are historically common among political leaders, Dr. Vinters notes. President Dwight Eisenhower suffered several while serving, as did British Prime Minister Winston Churchill. “Maybe what is most interesting is to speculate about what would have happened if Lenin had survived,” he says. “He could have been the leader of the Soviet Union well into his seventies and even eighties. How would that have changed history?”

“Though scientists and doctors of his time lacked even the terminology to describe cerebrovascular disease, certainly Lenin could have been diagnosed and treated had he lived in modern times,” says Philip A. Mackowiak, MD, MBA, professor and vice chair of the Department of Medicine at the University of Maryland School of Medicine and Chief of the Medical Care Clinical Center of the VA Maryland Health Care System. Dr. Mackowiak founded the annual CPC in 1995, and the program has since examined the lives and deaths of famous figures such as Edgar Allan Poe and Abraham Lincoln. “It is fascinating to consider how far medicine has come in fewer than 100 years, and interesting, indeed, to ponder how the course of history would be changed had Lenin lived.”

E. Albert Reece, MD, PhD, MBA, vice president for medical affairs of the University of Maryland and the John Z. and Akiko K. Bowers Distinguished Professor and Dean of the School of Medicine, says the conference captures the very essence of medicine. “As doctors and scientists, we are medical detectives seeking to unlock the secrets of human health,” says Dean Reece. “The CPC is an interesting exercise in the kind of creative problem-solving and innovative thinking that characterizes a great scientist and an outstanding physician.”

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