Chapter 4: Aerospace Neurology

In the practice of medicine, the neurologist is called upon to answer the following questions: (1) Does the patient have neurologic disease? (2) If so, what is the localization of the lesion or lesions? (3) What is the pathophysiology of the process? (4) What is the preliminary differential diagnosis? Utilizing the tools of the neurologic and medical history, the neurologic examination, ancillary studies, and one’s education, training, and experience, the neurologist arrives at a diagnosis. The aerospace medicine physician (evaluator) has the additional challenge of relating the neurologic condition to aviation safety and achieving an appropriate aeromedical disposition. Whether it is the aviation medical examiner (AME), flight surgeon, or Federal Aviation Administration (FAA) regulator, the aerospace medicine physician shoulders the responsibility of a determination that may decide one’s career in aviation or spaceflight. Considering the individual, and yet preserving aerospace safety, is a never-ending challenge for the aerospace medicine physician. The evaluator has the dual responsibility of applying the standards and also considering exceptions to the standards in allowing waivers from standards, while assuring aerospace safety.