Volumen 10 (2018): Edición 1 (June 2018)

Temporary loss of consciousness is unnerving for anyone, however the consequences in some professions can be devastating. This paper discusses the case of an Airline Transport Pilot License pilot who experienced a ‘funny turn’ resulting in loss of consciousness, with reference to the aeromedical decision-making process and a literature review.

Colour vision testing has been and remains a controversial subject in aviation. Despite this, colour testing methods have remained essentially unchanged in many years. This presentation reviews the relevance of colour testing methodologies to modern aviation and presents a review of recent literature relating to colour vision and how it is affected by various physiological states and changes occurring with various pathological conditions; and the relevance of these discoveries to current and future aeromedical certification processes.

A 50 year old male airline transport pilot licence (ATPL) pilot had been on a CASA audit requirement (CAR) for Non-Hodgkin’s Lymphoma since 2010. As part of his ongoing haematological medical surveillance a neck, chest, abdomen and pelvis CT scan in 2014 reported an “incidental” abnormality in his neck. Perusal of the first several articles raised from a “Google” search of the abnormality linked it with possible stroke, carotid dissection and death. Would CASA now cancel or suspend this pilot’s medical? Could this pilot become a casualty of VOMIT (victim of modern imaging technology¹)? If DAMEs were delegated the responsibility to be able to issue Class 1 certificates, how many would spend the time (and charge commensurately) to perform a more detailed literature search and critical appraisal to support an aero-medical decision one way or the other? This paper discusses the process and time taken to aero-medically assess a pilot who had an incidental radiological diagnosis of a rare condition.

This case presentation discusses an airline captain who suffered a cerebrovascular event. Despite extensive investigation, no underlying cause or contributing factors could be identified. He went on to make a full recovery from his stroke, and after two years applied for renewal of his medical certificate. This presentation discusses the aeromedical certification process, including the restrictions and health surveillance measures put in place once he was recertified.

This case report is about an Australian Army aircrewman who developed a sudden incapacitating visual disturbance. The case study explores the investigation pathway, differential diagnoses and the aeromedical implications. Although not all cases of visual disturbance have an underlying ophthalmological or neurological cause, and in fact might be quite benign, there is a possibility of a serious pathology of vascular or ischaemic aetiology affecting fitness to fly and recertification. History, signs, symptoms and investigation results are discussed in the context of the aeromedical handling of the case, and eventual return to flying duties after a restriction period. Unusual facets and possible contributors in this case study are the exposure to noxious fumes and vaporised nicotine (e-cigarettes). The implications of the latter are still unexplored in the aviation environment.

An asymptomatic 33 year old male Air Combat Officer was recommended to have a CT cerebral angiogram, based on a family history of a vascular anomaly. A 1-2mm aneurysm located in the cavernous portion of the internal carotid artery was discovered. Neurosurgical advice was obtained which indicated that the risk of haemorrhage from this aneurysm in this location is ‘practically zero’, and that there is no indication for any intervention. The fast jet environment does impose significant stress on the individual however, and aeromedical decision making is often more difficult when, despite the depth of evidence available, the risks remain unquantifiable. This paper discusses the literature review conducted, the risk factors for rupture and risks of rupture, precipitating events, treatment, monitoring, and advice for the affected individual. The aeromedical disposition of the affected individual is outlined.

A Royal Australian Navy aviator was diagnosed with a subarachnoid haemorrhage after sudden onset of occipital headache, the result of a small aneurysm of the left posterior inferior cerebellar artery. The aneurysm was surgically wrapped and clipped through a posterior fossa craniotomy, and the patient made a full and uncomplicated recovery. Except in rare cases, subarachnoid haemorrahge and intracranial aneurysms are generally considered to be disqualifying for military aviation. Even with good recovery of neurological functioning, complications such as seizures, risk of rebleeding, and de novo occurrence of other aneurysms are all significant concerns due to the risk of sudden incapacitation. This paper will examine the aeromedical factors particular to this case that influenced a favorable aeromedical decision-making outcome.