Implications of stroke and TIA

You may recall from your frequent review of the FAR Part 67 medical standards that there are fifteen medical conditions that are disqualifying by “history or clinical diagnosis.”  What, you didn’t know that?

OK, just kidding. Perusing the FARs isn’t an activity most of us invest our valuable time in, so if you already hold or will be seeking an FAA- issued medical certificate or special issuance, you can read on and learn how the FAA deals with this grouping of symptoms that is not uncommon in the aging pilot population.  

The medical condition we’re talking about is actually a number of different conditions characterized by a constellation of symptoms ranging from mild and barely noticeable to dramatic and potentially life threatening. Collectively, in FAR Part 67.109; .209; and .309(a)(3), the condition is a “transient loss of nervous system function(s) without satisfactory medical explanation of the cause.” We could easily wander deep into the forest of what in the FAA regulatory medicine world would fall into this category, but two conditions that fits into the regulation are strokes and transient ischemic attacks (TIAs), or “mini-strokes.”  

TIAs are short-duration events that usually last only for a few minutes, with complete resolution of the presenting symptoms within a few hours. TIAs are often precursors to a full-blown stroke, and often present with weakness and numbness or paralysis in the face or extremities, often on just one side of the body. Speech could be slurred or garbled, visual acuity can be diminished, and dizziness or loss of balance or coordination can often occur. TIAs can occur repeatedly, and if subsequent events happen in a different part of the brain, the signs and symptoms may be similar or different than previous experiences.

A TIA is a shot across the bow that makes the patient aware that there may be occlusive vascular disease in the brain circulation that is compromising blood supply. These little “snapshots” of events are “transient”—that is, they are short duration; and they result in a brief period of “ischemia”—the time when blood doesn’t have a clear and continuous conduit through the vessels in the brain to oxygenate and nourish brain tissue. Blood clots are often the culprits in TIAs, and clots can result from arteriosclerosis (“hardening” of the arteries), a heart attack, or an abnormal heart rhythm such as untreated atrial fibrillation, a common arrhythmia in older people.  

Stroke is a more aggressive result of cerebrovascular disease and often presents with the same symptoms of TIA, but more severe symptoms often occur, and there may be residual damage from a stroke that may or may not fully resolve over time. Neurological deficits include short- and long-term memory; executive function such as interpreting information and decision making; speech impairment; vision deficits; and motor function. Rehabilitation to recover those functions can be long term for some patients.

Neurologic conditions attract the FAA’s attention, so medical recertification after a stroke or TIA usually requires two years (that’s right, 24 months) of recovery followed by current neurological and neurocognitive testing to determine if there is any “aeromedically significant” residual deficits. In addition, cardiovascular testing also will be required to identify any evidence of heart disease.

Sometimes, though, the FAA is willing to consider an applicant for special issuance certification in less than two years if a definite cause for the stroke or TIA can be clearly and unequivocally identified, and appropriately treated to mitigate the risk of another event.

Portrait of Gary Crump, AOPA's director of medical certification with a Cessna 182 Skylane at the National Aviation Community Center.
Frederick, MD USA

Gary Crump

Gary is the Director of AOPA’s Pilot Information Center Medical Certification Section and has spent the last 32 years assisting AOPA members. He is also a former Operating Room Technician, Professional Firefighter/Emergency Medical Technician, and has been a pilot since 1973.

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