“Cerebrovascular disease” covers a spectrum of brain pathology that includes aneurysms, brain bleeds, tumors, and strokes or transient ischemic attacks (TIA). These conditions pose a risk for impairment or incapacitation that understandably makes the FAA more conservative.
The basic neurologic evaluation is an office evaluation with a board-certified neurologist, and, depending upon the actual medical history, imaging studies would be needed along with the treatment and hospital records. Determining the risk for a subsequent event is challenging, and that is how the FAA operates—determining an acceptable level of risk that keeps the system safe. In the case of stroke or TIA, the risk for a subsequent event is still there, and the FAA often requires a 24-month recovery and stabilization period before one can be considered for special issuance. Pilots with this history are often caught off guard by this seemingly onerous recovery time, but there is sound logic behind it. Not all strokes present the same way; some are very mild with symptoms no worse than tingling in the fingers or a mild but fast-recovering muscle weakness. Other symptoms can be much more dramatic such as speech impairment, loss of motor function on one side of the body, visual deficits, or worse. The FAA wait time of 24 months provides the patient with plenty of time to recover neurologically from the deficits that resulted from the event.
Neurocognitive testing for pilots is controversial in the aerospace medicine community, and the FAA is reevaluating the situations in which the testing would be required, but most cases involving the potential for neurologic deficit will require the assessment as part of the review process.