Guidance for medical examiners when assessing a patient for either a general topic or condition - Transient Ischaemic Attack.
Effect of aviation on condition
- Lowering of seizure threshold by relative hypoxia
Effect of condition on aviation
- Neuropsychological impairment e.g. impaired attention, concentration, memory
- Risk of incapacitation due to co-morbid conditions e.g. CVD, diabetes, AF etc.
- Overt incapacitation from event
- Neurological incapacitation.
Effect of treatment on aviation
- Impaired 'g' tolerance secondary to drug therapy
- Antiplatelet agents - haemorrhagic risk
Approach to medical certification
Based on the condition
- Diagnosis of TIA
- Exclusion of significant vascular pathology in other organs eg heart
- Estimate of seizure risk
- Estimate of TIA/CVA recurrence risk
- Estimate of cardiac event risk
Based on treatment
- Acceptable, stable treatment without significant side effects
- Management of co-morbidities e.g. cardiovascular disease, diabetes, hypertension etc.
- Nil recurrence of neurological episode(s) during 12 month period of surveillance from time of diagnosis
Risk assessment protocol - information required
On being diagnosed with a TIA please provide the following reports to CASA as a bundle as soon as they become available.
- Hospital admission notes
- Results of Brain imaging
- Results of blood tests
- Hospital discharge letter
- Initial Neurologist assessment
In many cases CASA will be able to make a preliminary assessment of the prospects for future certification on the basis of these reports and before the mandatory 12 month grounding period is complete.
In cases where the prognosis is less certain a follow up Neurologist report after the completion of the 12 month grounding period may be required.
A Cardiologist report may also be required after the completion of the mandatory 12 month grounding period.
Renewal (if applicable)
Where CASA is able to issue a medical certificate, at renewal, it requires a report from the Neurologist/Physician monitoring the applicant's TIA. The specialists report should detail:
- Clinical status
- any neurological episodes in the preceding 12 months
- any cardiac episodes in the preceding 12 months
- Investigations conducted
- results of a recent (within the last 3 months) stress test
- any relevant investigations undertaken in the interim
- control of cardiovascular risk factors
- Proposed monitoring and follow-up plan
- CHA2DS2VASC score (if relevant)
- Prognosis including annualised percentage risk of:
- recurrence of TIA
- Myocardial Infarction
- references for opinion.
- Grounding required immediately and notification to CASA
- Because of risk of seizure and recurrence of TIA or CVA, a minimum period of 12 months grounding after TIA will be required
- Applicants with unacceptable recurrence risk and/or risk of myocardial infarction may not meet the required standard for medical certification
- If a certificate can be issued, permanent annual requirement for cerebrovascular and cardiovascular risk assessment may be required
- If a certificate can be issued, permanent Multi-crew (Class 1) or Safety Pilot (Class 2) restriction may be required
- Medical therapy for management of risk factors for cardiovascular and cerebrovascular disease
- Unacceptable risk of future vascular events associated with combined history of TIA and co-morbidities
- Significant coronary artery disease - see coronary artery disease advice
Pilot and controller information
- TIA is an aero-medically significant medical condition
- It is a significant risk factor for further TIA, Stroke and Heart Attack
- Pilots and controllers who have been diagnosed with TIA are required to ground themselves and notify this condition to their DAME or CASA
- Applicants with unacceptable stroke, TIA or heart attack risk may not meet the required standard for medical certification
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The clinical practice guidelines is provided by way of guidance only and subject to the clinical practice guidelines disclaimer.