Cerebrovascular events can be classified as ischaemic or haemorrhagic events, depending on the primary cause.
These can be divided in transient ischaemic attacks (TIAs), and strokes or cerebral infarction. Reversible ischaemic neurological deficits (RINDs) is a term sometimes used to describe an ischaemic event with neurological deficit lasting more than 24h but less than 48h.
There is an increased cardiovascular risk associated with ischaemic strokes and TIAs. Certification will depend on the presence or absence of sequelae, the likelihood of seizure, the underlying pathology and the risk of recurrence conferred by this pathology. Some possible causes are:
In many instances the cause remains unclear, all investigations being negative. In such cases the final diagnosis will often be that of probable occult vascular or cardiac disease, such as Paroxysmal Atrial Fibrillation, or Patent Foramen Ovale (PFO) which should be looked for.
Haemorrhagic stroke may be caused by the rupture or leak of an arterial aneurysm, resulting in a subarachnoid haemorrhage. Aneurysms with a diameter of less than 7 mm have a low probability of rupturing. Occasionally, with angiography, no pathological vessel is found causing subarachnoid haemorrhage. This situation has a more favourable prognosis.
Other causes of intracranial bleeding include anticoagulants, arteriovenous malformations, amyloid angiopathy and hypertensive cerebral haemorrhages.
Class 1 and 3 certification is unlikely in most cases of ischaemic strokes or TIAs.
Class 2 certification may be possible in some cases of ischaemic strokes or TIAs, in the absence of sequelae, or elevated risk of seizure, following a two to three years waiting period. Exclusion of identifiable vascular disease or cardiac ischaemia is required. Restrictions usually apply.
Class 1, 2 and 3 certification may be possible in some cases where an adequately treated cause has been identified for the cerebro-vascular event and there is absence of safety relevant sequelae or elevated risk of seizure. For example, in the case where a large patent Foramen Ovale (PFO) is the probable cause for an ischaemic event and closure has been successfully undertaken.