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Old 19th May 2017, 08:08   #1 (permalink)
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Join Date: Apr 2015
Location: Hong Kong
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CASA class2 head injury more than 10 years ago

Guys,

I am applying CASA medical class 2.

I reported I had a head injury more than 10 years ago. I had no surgery but had some imaging and stayed in the hospital for 10 days.

It is reasonable that CASA asked for further information.

As the accident was long time ago, the MRI image was lsot.

I attach all the records the hospital has kept for the accident in 2004 including:

I provided CASA the following documents.

1. Emergency Department Report
2. Discharge summary
3. Consultation summary

It is anticipated that I have to get some tesst and I found myself suit in the clause in Designated Aviation Medical examiner's Handbook(2004) p.2.5-14.

2. Applicants with PTA from 30 minutes to 24 hours, with a normal MRI and EEG, are acceptable after 12 months. If a seizure occurred in the first week after trauma in ana dult, a longer interval before re-licensing is required. Such cases are assessed individually.


Was anyone in the similar situation?
What type of EEG did you have? What did your specialist have to write in the report? Did you do any imaging?
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Old 19th May 2017, 09:15   #2 (permalink)
 
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Hi there,

I have had similar, I suffered a head injury in 2005 when some kind person knocked me off my bike while I was out training and left me unconscious in the road. At the time I was concussed and had a small subdural haematoma visible on the head CT but was this was without sufficient mass to allow it to be treated conservatively. I spent approx 2 weeks in hospital due to other musculo-skeletal injuries and was then discharged, I did not receive any neuro follow-up. Subsequently I had no long term issues related to the above and am fit and healthy.

I obtained my Class 2 initial in 2010 from the UK CAA. At the time I needed to provide a report by a consultant neurologist who reviewed my history. The CAA AMS subsequently granted me a Class 2 initial without restriction.

In 2012 I went to obtain my Class 1 initial with the UK CAA. I was again required to submit a further neurologist's report along with a recent brain MRI. This show absolutely no evidence of injury and was described by the radiologist as "very satisfactory". The neurologist's report however raised the issue of PTE (post traumatic epilepsy) and based on several studies, estimated my risk of developing PTE to be <0.5% per annum, decreasing with time. The CAA/EASA require a risk of <0.1% for an unrestricted Class 1 so I have found myself with a long term OML. I have told that this can be reviewed again in 2020, this will be 15 years post accident.

Last edited by Fostex; 26th May 2017 at 09:05.
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Old 19th May 2017, 09:49   #3 (permalink)
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Quote:
When considering recertification, a residual risk of PTE of 1% or less is acceptable, given
that the prevalence of epilepsy in the community is 0.33%.
Conditions that require careful assessment and which most commonly result in a "fail"
assessment are: epilepsy, intracerebral haematoma, , persisting CSF fistula, primary open
cerebral laceration, and the presence of any significant permanent neurological deficit.
Seems CASA's standard is not as strict as CAA, the PTE required is less than 1%
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Old 19th May 2017, 11:50   #4 (permalink)
 
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Now that is fascinating, I wonder where they get the 0.33% figure. A lot of medical literature in the area of PTE would dispute that.

Then again, the real answer is that it is a calculated statistical risk and no one really knows!

Last edited by Fostex; 19th May 2017 at 12:03.
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Old 3rd Jun 2017, 07:43   #5 (permalink)
 
Join Date: Jun 2017
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Quote:
Originally Posted by Fostex View Post
Hi there,

I have had similar, I suffered a head injury in 2005 when some kind person knocked me off my bike while I was out training and left me unconscious in the road. At the time I was concussed and had a small subdural haematoma visible on the head CT but was this was without sufficient mass to allow it to be treated conservatively. I spent approx 2 weeks in hospital due to other musculo-skeletal injuries and was then discharged, I did not receive any neuro follow-up. Subsequently I had no long term issues related to the above and am fit and healthy.

I obtained my Class 2 initial in 2010 from the UK CAA. At the time I needed to provide a report by a consultant neurologist who reviewed my history. The CAA AMS subsequently granted me a Class 2 initial without restriction.

In 2012 I went to obtain my Class 1 initial with the UK CAA. I was again required to submit a further neurologist's report along with a recent brain MRI. This show absolutely no evidence of injury and was described by the radiologist as "very satisfactory". The neurologist's report however raised the issue of PTE (post traumatic epilepsy) and based on several studies, estimated my risk of developing PTE to be <0.5% per annum, decreasing with time. The CAA/EASA require a risk of <0.1% for an unrestricted Class 1 so I have found myself with a long term OML. I have told that this can be reviewed again in 2020, this will be 15 years post accident.
Hi Fostex,

I have a very similar situation to you regarding the injury, although I am going for my initial Class 1 medical, without having had a class 2. I did not lose conciseness or have any seizures, and I made a full recovery (9 years ago).

I am going to attend the initial medical armed with as much information as possible, do you have any tips at all? I am getting a written report from the surgeon who I was under the care of, and my GP, confirming no follow ups or issues.

What was it that made them estimate your seizure rate so high? Was it based on your age, previous history etc?

Any advise would be appreciated.

Thanks
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Old 3rd Jun 2017, 09:25   #6 (permalink)
 
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In my case my head injury was classed as severe due to the subdural haematoma. Any intra cranial bleeding, no matter how benign, causes a head injury to be classed as severe under the CAA guidance.

The guidance material is here :- https://www.caa.co.uk/Aeromedical-Ex...e-material-GM/

With the head injury material here - https://www.caa.co.uk/WorkArea/Downl...?id=4294973901 - and here https://www.caa.co.uk/WorkArea/Downl...?id=4294973700

In my case most of the criteria for my head injury would have classed it as moderate, GC > 9, short LOC etc. However my intracranial haemorrhage instantly put me in the severe category.

Show that guidance material to your consultant, you may need a neurologist as well as the surgeon, and make sure that they are clear on what they must include in the report.

Best of luck.
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Old 3rd Jun 2017, 18:33   #7 (permalink)
 
Join Date: Jun 2017
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Thanks.

So I would be going for an initial assessment, and I'm thinking it's not even worth it if its that black and white that I will get an OML license.

I'm waiting to here back from the neurologist and my Dr to see what their reports say.
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Old 3rd Jun 2017, 19:35   #8 (permalink)
 
Join Date: Jun 2017
Location: London
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Thanks for the reply.

ahh OK, thats unfortunate.

I saw that information on the head injury sheet from the CAA, I thought that it might just apply to people already have a class 1 and have suffered an injury, and an Initial Class 1 would be based entirely on the opinion/test results. It just seems worded towards only being for renewals.

So I guess if my head injury is considered "severe" for whatever reason, I would not receive a Class 1 full stop, as they don't issue initial class 1's with OML restrictions?

I'm hoping I won't be in that category, as I don't think I fulfil any of the criteria, but I'm waiting for the reports back.
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