Transient Global Amnesia (TGA)

Guidance for medical examiners when assessing a patient for either a general topic or condition - Transient Global Amnesia.

Aeromedical implications

Effect of aviation on condition

  • Some episodes of TGA have identifiable triggers
  • Known triggers for TGA that may be experienced in the aviation context include:
    • physical exertion
    • emotional stress
  • Other triggers not normally associated with aviation include:
    • painful experience
    • medical procedures
    • cold or hot water immersion
    • sexual intercourse.

Effect of condition on aviation

  • Overt incapacitation:
    • acute impairment of memory may impair ability to safely navigate and operate aircraft

Effect of treatment on aviation

  • There is no treatment for TGA

Approach to medical certification

Based on the condition

  • Confirmed diagnosis of TGA
  • Exclusion of other diagnoses
    • transient ischaemic amnesia
    • transient epileptic amnesia
  • Migraine is present in 25-33% of cases which may require treatment
  • Avoidance of identified triggers.

Demonstrated stability

  • Absence of symptoms of Transient Global Amnesia, Transient epileptic amnesia and Transient ischaemic amnesia for a period of one year
  • Absence of recurrent episodes of TGA

Risk assessment protocol - information required

New cases

  • CASA requires a report from a Neurologist with respect to:
  • Diagnosis
  • Clinical status
    • history of condition
    • eye witness account of episode
    • symptoms, including any visual or neurological symptoms, loss of consciousness
    • onset, duration, extent of retrograde and anterograde amnesia
    • identified precipitating factors
    • any history of
      • head injury, faints, fits or funny turns
      • migraine (see severe headache section)
      • cardiovascular or cerebrovascular disease
      • family history of epilepsy
    • cardiovascular risk factor assessment
    • hospital assessment
    • results of physical and neurological examination
    • progress
  • Investigations conducted
    • results of any imaging performed
  • Management
    • treatment and effectiveness
    • side-effects
    • monitoring
  • Follow-up plan.

CASA requires a review from a Neurologist 12 months post-event with respect to:

  • Diagnosis following 12 month period of observation
  • During 12 month period of observation:
    • any recurrent episodes of transient amnesia
    • any history of faints, fits or funny turns
    • results of any additional investigations.

Renewal

CASA requires a review from a treating doctor (GP or neurologist) with respect to:

  • Any recurrent episodes of transient amnesia
  • Any history of faints, fits or funny turns
  • Results of any additional investigations

Indicative outcomes

  • Initial notification to CASA and grounding required on diagnosis for a minimum period of 12 months
  • Clearance by CASA required before exercising privileges
  • Due to the risk of recurrent TGA all classes of medical certificates may be subject to long term restriction (e.g.multi-crew or safety-pilot)

Unfavourable

  • Any form of seizure disorder
  • Transient epileptic amnesia
  • Transient ischaemic amnesia

Pilot and controller information

  • TGA is an aero-medically significant medical condition.
  • There is no definitive test for TGA - it is a clinical diagnosis
  • Pilots and controllers who have been diagnosed with TGA are required to ground themselves and notify this condition to their DAME or CASA
  • Grounding required on diagnosis for a minimum period of 12 months for all classes
  • After 12 months a restricted certificate (multi-crew or safety-pilot) may be possible

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Disclaimer

The clinical practice guidelines is provided by way of guidance only and subject to the clinical practice guidelines disclaimer.

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