![]() History is imperative and it is mandatory to try to differentiate neurological from cardiological causes. It is recognised that terms such as ‘blackout’, ‘loss of consciousness’ and ‘syncope’ are open to interpretation in differentiating altered state of consciousness from vertigo, hysterical fugues, concussion, transient global amnesia or simple loss of vision. CASA will consider each person on his/her merits and does not impose any blanket restriction due to diagnosis of headache (1). It is important to distinguish migraine from transient ischaemic attack and also acknowledge the potential for migraine-induced stroke. A proper history defining quality of headaches, exacerbating and relieving factors, frequency, evolution, associated features, such as photophobia, phonophobia, visual symptoms, paraesthesia, severity and effectiveness of therapy are important deciding factors. This is a concept favoured by the author (1) What must be distinguished are primary headaches from secondary headaches, consequent to other causes, such as neuralgia, tumours or arteritis. What follows will offer a succinct summary of the contents of the Guidelines.ĬASA has adopted an approach to headache which favours a continuum of headache with tension-type headache at one end of the spectrum and migraine at the other. This clearly reads like a textbook of neurology and to do it full justice would be well beyond the scope of an overview such as this. ![]() ![]() Topics covered in the Guidelines included: headache blackouts loss of consciousness and syncope disequilibrium seizures head injuries neurosurgery cerebral infarcts infections dementia and degenerative diseases extra-pyramidal diseases demyelination tumours and peripheral neuropathy (1). It seemed appropriate to commence such an overview with a review of the Civil Aviation Safety Authority (CASA) Guidelines (1). What follows is that overview of ‘Neurology in Aviation’. The content of this paper does not specifically address many of the additional factors that are relevant to aviation within ADF operations, which may enforce more rigorous restrictions and expectations upon aircrew. Hence it was felt appropriate to offer a summary of the presentation to Journal of Military and Veterans’ Health to capitalise on the research undertaken and to offer as comprehensive an overview as time and space would allow. Time allocation for the overview was 1½ hours, which really only permitted the broadest of overviews. While it is accepted that aircrew in the ADF must achieve the accepted standards relevant to all aircrew, it is necessary to recognise that they may function within a much more hostile environment, as may occur in theatres of war or may be relevant to flying more sophisticated fighter planes, thereby necessitating additional considerations beyond those relevant to normal pilots. This includes clinical management of aircrew, determination of fitness to fly and medical support to ADF flying operations …”. The aim of the course is “… to prepare ADF medical officers and civilian health practitioners in order to provide aviation medical services to the ADF as AVMOs. When asked by RAAF Edinburgh to provide an overview of neurology in aviation for the aviation medical officer (AVMO) course and the AVMO refresher course, the magnitude of the task was more than evident.
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