Return to flying after head injuries: a review.

The pathology of head injury is discussed in relation to severity and to the chance of recovery. Return to flying status, then, depends mainly on the hazard of subsequent post-traumatic epilepsy (PTEP). Assessment of the threat of PTEP is based on the incidence of onset of PTEP within 1 year (75%) and 2 years (85%) of head injury in those who will develop the complication. Clear risk markers which increase the chances of later PTEP include past history of febrile convulsions, family history of epilepsy, "early" PTEP, intracranial haematoma, and depressed skull fracture. The persisting risk in depressed skull fracture is itself adversely affected by early epilepsy, dural laceration, focal neurological signs, and post-traumatic amnesia longer than 24 h. Permanent prohibition on grounds of initial severity can rarely be warranted. A cautious open-minded assessment of each individual by AMEs with specialist referral where indicated is recommended.