Passing Medical Exam with Cavernous Hemangioma
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Hi. I'm just starting to look at working on getting my private pilot's license. One issue is that I have a cavernous hemangioma which I had read can cause issues. I sent an email to my friend with my history below and he passed it along to his medical examiner:

In March 2018 a cavernous hemangioma was found in my brain. It was discovered while doing a brain MRI (with and without contrast) to rule out any neurological causes of my eyes shaking. By the time I had the MRI I no longer was getting the shaking. My GI doctor and I believe it was caused by Bentyl that I started taking recently before I had the shaking and stopped after I quit taking it. After the MRI that found the cavernous hemangioma I had a CT scan to make sure there wasn't any bleeding from it which there wasn't. I've since had an MRI in 2019 and 2021 both showing that nothing had changed. I've read people sometimes have issues getting certified to fly due to the risk of a seizure (have never had any in my life). Was wondering if you could help let me know if I would have issues or not. Thanks.

This was the response from the medical examiner.

Good afternoon!  Thank you for your question.

 

With cavernous hemangiomas (CH) , most of which are asymptomatic and are found incidentally, the FAA has concerns about their potential to cause sudden incapacitation in the cockpit.  This incapacitation can be from a bleed that can contribute to a stroke or loss of consciousness, as well as a seizure from bleeding.

 

Any and all documentation and images will need to be forwarded to the FAA for consideration, this should include a detailed exam from a Neurologist in which they provide their opinion about the potential for the CH to bleed or have other complications over the next 1-5 years.

 

In my experience, the FAA gets anxious about CH, even if it has been stable for years.  As a result they will push to have surgical correction, to best minimize the risk.

 

Below is an article from the Federal Air Surgeon Medical Bulletin from a few years back.  Although it is old, it still addresses many of the FAA’s questions and concerns. https://www.faa.gov/other_visit/aviation_industry/designees_delegations/designee_types/ame/fasmb/media/cerebral.pdf

I was wondering what my first steps should be with this. My neurologists has said he's happy to sign a note of approval for me but neither he nor I are sure exactly what we should put there besides potentially what the medical examiner mentioned. Appreciate any help. Thanks.

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Brian Leighty: 
 

I was wondering what my first steps should be with this. My neurologists has said he's happy to sign a note of approval for me but neither he nor I are sure exactly what we should put there besides potentially what the medical examiner mentioned.

Like the article said – “Submission requirements include all pertinent medical records, current neurologic specialist evaluation and report, the names, dosages, and side-effects of medication, when applicable.”  That means essentially “everything in your medical history.”  Beyond that, you need the advice of an expert in difficult medical certifications, like Dr. Bruce Chien, who will probably chime in within a couple of days.  You can also consult him via his web site www.aeromedicaldoc.com.  And you want to get such advice and consultation before you make application to the FAA for a medical certificate, because if your application is insufficient, it will be denied, and it will be that much harder to reapply later.

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Brian, The reply in your original quote is dead on. Since he is correct, they really want surgical correction, I'd encourage you to at least consider light sport flying.  Despite the fact that these are generally benign, I'd be somewhat adverse to having Any  brain procedure on behalf of a federal bureaucracy…..