Hydrocephalus

Greg Bockelman

Touchdown! Greaser!
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Greg Bockelman
I was contacted by a lady who has hydrocephalus. She saw somewhere that I had had hydrocephalus. But unlike my case, hers is ongoing.

She wants to become a professional pilot. Is it possible for her to get a First Class medical? She did a consultation and was told that it would get deferred. I don’t want her to go down that road if there is a chance that it would eliminate future options.
 
I was contacted by a lady who has hydrocephalus. She saw somewhere that I had had hydrocephalus. But unlike my case, hers is ongoing.

She wants to become a professional pilot. Is it possible for her to get a First Class medical? She did a consultation and was told that it would get deferred. I don’t want her to go down that road if there is a chance that it would eliminate future options.
Mine opinion, We need healthy people in Aviation Industry, but we never know on daily to daily basis she will be normal for sure, but what happens on the ONE day when sheets hit the fan. Not to disrespect but there are certain jobs in aviation don't req medical ✌️. So please no Pilot way! IT'S SERIOUS SAFETY ISSUE
 
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Mine opinion, We need healthy people in Aviation Industry, but we never know on daily to daily basis she will be normal for sure, but what happens on the ONE day when sheets hit the fan. Not to disrespect but there are certain jobs in aviation don't req medical ✌️. So please no Pilot way! IT'S SERIOUS SAFETY ISSUE

If the FAA says they are safe to fly what is the problem?
 
While we wait for someone who actually knows how CAMI handles it, here are the symptoms as described by the Mayo Clinic:

Young and middle-aged adults

Common symptoms in this age group include:
  • Headache.
  • Sluggishness.
  • Loss of coordination or balance.
  • Loss of bladder control or needing to urinate often.
  • Vision problems.
  • Decline in memory, concentration and other thinking skills that may affect job performance.

Older adults

Among adults 60 and older, the more common symptoms of hydrocephalus are:
  • Loss of bladder control or needing to urinate often.
  • Memory loss.
  • Progressive loss of other thinking or reasoning skills.
  • Trouble walking, often described as shuffling or the feeling of the feet being stuck.
  • Poor coordination or balance.
But I have to say, those symptoms look like they would be troubling to the FAA as far as I can tell . . .

Looking a little further it appears the application would be deferred but might be eligible for a Special Issuance, so I guess it depends on symptoms and any other factors, and I suspect it would be an expensive process.
 
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Someone in my family has hydro. I asked one of the FAA docs at osh about flying. He said there are pilots with first class medicals flying fir the airlines. But, Knowing there are many symptoms of hydro, talking to an experienced AME would be a great next step.
 
Here is the scoop on hydrocephalus. There are many different types and many different causes. The diagnosis of hydrocephalus is based on imaging studies showing that the fluid filled spaces in the brain(ventricles) are larger than they should be. Without knowing the specifics of her case, any comments about whether she can pass a medical is pure speculation and may have nothing to do with reality. While some of the AME's may provide a different opinion based on FAA regs, the truth is, hydrocephalus is a diagnosis with many different variations. My reading of the FAA regs however seems to support my opinion.
 
With hydrocephalus, EVERYTHING depends on
How severe
Etiology (cause)
Rate of progression
Presence of a functional VP shunt.
 
Ok, so follow up questions. How goes she go about determining if she has a reasonable chance of passing the physical before it goes live? She knows it’s not severe and that the shunt is operational. How does one figure out a cause when it started as an infant? As to the rate of progression, I would think that wouldn’t be an issue since it has been stable for the last 50 years or so.
 
Greg, I have Hydrocephalus. It was discovered when a sinus X-ray, maybe MRI, showed a section of my brain not intended to be imaged. I called my uncle (a very prominent neurosurgeon at U Washington) and he referred me to one of his students.

The result was that they measured the brain with radiology, and said ‘come back in a year.’

Did that, more radiology. Result was no progression. Disclosed all to the AME. This and the ‘successful life test’ led to a ‘go fly’ proclamation.

I wish the same for your friend.

-Skip
 
Ok, so follow up questions. How goes she go about determining if she has a reasonable chance of passing the physical before it goes live? She knows it’s not severe and that the shunt is operational. How does one figure out a cause when it started as an infant? As to the rate of progression, I would think that wouldn’t be an issue since it has been stable for the last 50 years or so.
I think the standard answer is to consult an AME before submitting MedXpress. If nothing else she'll have a chance to look at the projected costs and time frame and decide if it's worth it.
 
Ok, so follow up questions. How goes she go about determining if she has a reasonable chance of passing the physical before it goes live? She knows it’s not severe and that the shunt is operational. How does one figure out a cause when it started as an infant? As to the rate of progression, I would think that wouldn’t be an issue since it has been stable for the last 50 years or so.
If she has had the same shunt for 50 years and it has not been revised at all during those 50 years it is quite likely that the shunt is no longer functioning. My first visit would be to a neurosurgeon before seeing an AME to evaluate her for hydrocephalus and evaluation of the shunt. There is a strong possibility that the neurosurgeon knows an AME they have worked with in the past and the cooperation of the two may save her time, and expense in determining whether she can pass the medical and what needs to be done in order to pass the medical if she can.
 
After 5 years it's quite certain the shunt is not functioning and is superfluous. Then all you have left is the N-surgeon's consultation as to stability of the "let's not remove it" device, and stability of the hydrocephalus IF you can show successful life function in the interim)!

B
 
After 5 years it's quite certain the shunt is not functioning and is superfluous. Then all you have left is the N-surgeon's consultation as to stability of the "let's not remove it" device, and stability of the hydrocephalus IF you can show successful life function in the interim)!

B
Not to get in a pssing match but after 5 years the vast majority of shunts are very much functional. That being said the shunt of today is very different from the shunt of 50 years ago. Not only are different materials used, the valves are very different as well. As for "let's not remove it" that is very good advice. Even a "nonfunctional"shunt is still probably draining some fluid though probably not at a measurable level. The issue with hydrocephalus is the radiological presence of inceased ventricular size(the fluid filled spaces in the brain are larger than they should be) does not always coincide with clinical presentation. In fact, I would submit to you the issue the FAA is interested in or should be interested in is not the presence of hydrocephalus(by the way which is present on many radiological studies done for other reasons and is not clinically significant) but the presence or absence of symptoms and signs.
 
Then he’s outta luck, FAA wise :(.
If a hydrocephalus is shunt dependent they will not approve.

To Douglas 393, since you are knowledgable, you also know that the signs and symptoms of shunt failure in a shunt dependent person, at the earliest are NOT generally recognized by the person with the hydro. And they ARE subtle and neurocognitive. By the time we got something on a MOCA or a Denver, it’d be waaay too late.

In an ideal world, it would be approvable but if the did such it would be cogscreen ever six months and HIMS AME interview every 3 months with no authority for field approval.

With staffing as it is…this is not a happening thing.
 
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Then he’s outta luck, FAA wise :(.
If a hydrocephalus is shunt dependent they will not approve.

To Douglas 393, since you are knowledgable, you also know that the signs and symptoms of shunt failure in a shunt dependent person, at the earliest are NOT generally recognized by the person with the hydro. And they ARE subtle and neurocognitive. By the time we got something on a MOCA or a Denver, it’d be waaay too late.

In an ideal world, it would be approvable but if the did such it would be cogscreen ever six months and HIMS AME interview every 3 months with no authority for field approval.

With staffing as it is…this is not a happening thing.
Cannot comment on the FAA view but certainly the way you put it is reasonable. That being said books have been written on hydrocephalus and the condition is quite complicated and varied. As for shunt failure symptoms they can be quite variable and can range from subtle to not so subtle to quite obvious. The devil is in the details and can be often clouded by denial of the presence of symptoms. At the end of the day shunt treated hydrocephalus appears to be a disqualifying condition.
Unfortunately there often is a big difference between the radiological diagnosis of hydrocephalus, and the clinical diagnosis. Whether this distinction is apparent to the FAA I will defer to you.
 
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