Cerebrovascular Disease
Item 46: FAA Clinical Guidelines for CVA, TIA Intracranial Bleed, AVM, Aneurysms
Apr 2014
Guidance is compiled and interpreted by professional pilots and physicians at FlightPhysical.com from the 2014 AME Guide pages 122-127, FAA and FDA web data (www.FAA.gov & www.FDA.gov), instructions specified in the Aeronautical Information Manual, Federal Air Surgeon Bulletins from 1999-2015, and 14 CFR Part 61 and Part 67 (the FARs).
Decision Grid - Aerospace Medical Dispositions
DISEASE/CONDITION |
CLASS |
EVALUATION DATA |
DISPOSITION |
---|---|---|---|
Transient Ischemic Attack (TIA): | All | - All pertinent inpatient and outpatient medical records, including work up for any correctable underlying cause(s) - Current neurologic evaluation by a neurologist with a detailed written report addressing motor, sensory, language, and intellectual/cognitive function; all medications (dosage and side effects) - MRA or CTA of the head and neck - Current FBS and lipids - Carotid artery ultrasound studies - Cardiovascular Evaluation (CVE) with EST, a 24-hour Holter monitor and M-mode / 2-D echocardiogram (usually TTE but TEE optional if clinically indicated) - Neurocognitive testing: may be required as clinically indicated |
Requires FAA Decision |
Completed Stroke (ischemic or hemorrhagic); | All | - All pertinent inpatient and outpatient medical records, including work up for any correctable underlying cause(s) - Current neurologic evaluation by a neurologist with a detailed written report addressing motor, sensory, language, and intellectual/ cognitive function; all medications (dosage and side effects) - MRA or CTA of the head and neck - Current FBS and lipids - Carotid artery ultrasound studies: required for ischemic strokes; otherwise only if clinically indicated - Cardiovascular Evaluation (CVE) with EST, a 24-hour Holter monitor and M-mode / 2-D echocardiogram (usually TTE but TEE optional if clinically indicated) NOTE: required for ischemic stroke; for hemorrhagic stroke is required if clinically indicated (for example in a hemorrhagic stroke due to hypertension, even if felt to be transient hypertension) - Neurocognitive testing to SPECIFICATIONS FOR NEUROPSYCHOLOGICAL EVALUATIONS FOR POTENTIAL NEUROCOGNITIVE IMPAIRMENT required for all strokes. For hemorrhagic strokes, the bleeding must be resolved as documented by CT or MRI |
Requires FAA Decision |
Subdural, Epidural or Subarachnoid Hemorrhage | All | - All pertinent inpatient and outpatient medical records, including work up for any correctable underlying cause(s) - Current neurologic evaluation by a neurologist with a detailed written report addressing motor, sensory, language, and intellectual/ cognitive function; all medications (dosage and side effects) - CT or MRI of the head - Additional testing such as EEG, neurocognitive testing, etc., may be required as clinically indicated |
Requires FAA Decision |
Intracranial Aneurysm or Arteriovenous Malformation | All | Submit all pertinent medical records, current neurologic report, name and dosage of medication(s) and side effects |
Requires FAA Decision |
Intracranial Tumor16 | All | Submit all pertinent medical records, current neurologic report, name and dosage of medication(s) and side effects |
Requires FAA Decision |
Pseudotumor Cerebri (benign intracranial hypertension) | All | Submit all pertinent medical records, current neurologic report, name and dosage of medication(s) and side effects |
Requires FAA Decision |
15 Complete neurological evaluations supplemented with appropriate laboratory and imaging studies are required of applicants with the above conditions.
16 A variety of intracranial tumors, both malignant and benign, are capable of causing incapacitation directly by neurologic deficit or indirectly through recurrent symptomatology. Potential neurologic deficits include weakness, loss of sensation, ataxia, visual deficit, or mental impairment. Recurrent symptomatology may interfere with flight performance through mechanisms such as seizure, headaches, vertigo, visual disturbances, or confusion. A history or diagnosis of an intracranial tumor necessitates a complete neurological evaluation with appropriate laboratory and imaging studies before a determination of eligibility for medical certification can be established. An applicant with a history of benign supratentorial tumors may be considered favorably for medical certification by the FAA and returned to flying status after a minimum satisfactory convalescence of 1 year.
This page discussed the Cerebrovascular Disease portion of the Neurologic section of the Fight Physical Examination required of pilots.
Reminder: use FlightPhysical.com to familiarize yourself with aviation medical regulations and guidelines, but always discuss your specific situation with one or more AMEs before dedicating resources toward expensive clinical workups. Find an AME now