Brain bleed
What the FAA's documents say about brain bleed, in plain words, with the FAA's own words one press away.
FAA term: Brain Bleed (Intracranial Hemorrhage, Cerebral Hemorrhage, Ruptured Aneurysm, Subarachnoid Hemorrhage, Subdural/Epidural Hemorrhage)Covers: All classes
Show the FAA's words: which classes the FAA's table covers
BRAIN BLEED (Intracranial Hemorrhage, Cerebral Hemorrhage, Ruptured Aneurysm, Subarachnoid Hemorrhage, Subdural/Epidural Hemorrhage) All Classes
- For a hemorrhage due to trauma the table says see the Traumatic Brain Injury section. Crosscheck's page on concussion and head injury is written from the FAA's Head Injury or Brain Injury table, which names traumatic brain injury (TBI).
- If a shunt was placed, the table says see the Hydrocephalus section, which has its own page.
AVM of the brain or spinal cord
The FAA's table for an arteriovenous malformation (AVM) of the brain or spinal cord has a row that includes ruptured or repaired, and has its own page.- The table says that if associated with a seizure, see that section, and that an additional recovery period and testing (such as EEG) may apply. Crosscheck has a page on seizures and epilepsy, written from the FAA's Seizure and Epilepsy tables.
Short version
The disposition table has one row, any history of a spontaneous intracranial hemorrhage not due to trauma.
| Situation | What the examiner does | Pathway |
|---|---|---|
| Row AA spontaneous intracranial hemorrhage not due to trauma | Defers to the FAA | Special Issuance |
Show the FAA's words: the FAA's table for Brain bleed
- Row A · Special Issuance
Any history of a spontaneous intracranial hemorrhage not due to trauma. The table's examples may include a ruptured AVM, a subarachnoid hemorrhage (SAH), and a subdural or epidural hemorrhage. If due to trauma, it says see the Traumatic Brain Injury section. After any required recovery period (two (2) years if a craniotomy was performed, one (1) year for a subarachnoid hemorrhage), the table lists what to submit for FAA review, and the examiner defers and submits the information to the FAA for a possible Special Issuance.
A. Any history of a Spontaneous intracranial hemorrhage not due to trauma* (Examples may include ruptured AVM, Subarachnoid hemorrhage [SAH], Subdural, or epidural hemorrhage) (*If due to TRAUMA, See - Traumatic Brain Injury section, subdural hematoma, epidural hematoma, or subarachnoid hemorrhage.) … Required recovery periods: • If craniotomy performed: Two (2) years • Subarachnoid hemorrhage: One (1) year … After any required recovery period, submit the following for FAA review: … DEFER Submit information to the FAA for a possible Special Issuance
- A note on the table, 1
The table's footnote says if due to trauma, see the Traumatic Brain Injury section, and names subdural hematoma, epidural hematoma, or subarachnoid hemorrhage.
(*If due to TRAUMA, See - Traumatic Brain Injury section, subdural hematoma, epidural hematoma, or subarachnoid hemorrhage.)
- A note on the table, 2
The table's last lines say if associated with a seizure, see that section, and an additional recovery period and testing (such as EEG) may apply; and if a shunt was placed, see the Hydrocephalus section.
If associated with a seizure – see that section. An additional recovery period and testing (such as EEG) may apply. If a shunt was placed – see the Hydrocephalus section.
The FAA pathways for brain bleed
Your step-by-step plan
Step 1: The recovery period
What the table sets before anything is submitted for FAA review.After any required recovery period, the table lists what to submit for FAA review.
Required recovery periods
- Two (2) years
- One (1) year
Show the FAA's words: The recovery period
Required recovery periods: • If craniotomy performed: Two (2) years • Subarachnoid hemorrhage: One (1) year
After any required recovery period, submit the following for FAA review:
FAA source: Brain Bleed. FAA date 25 January 2023; checked by Crosscheck 14 October 2026.
Step 2: The neurological evaluation
From your treating neurologist, a vascular neurologist preferred.Within 90 days before the examA current, detailed neurological evaluation that meets FAA Specifications for Neurologic Evaluation, from a clinic visit with your treating neurologist (vascular neurologist preferred) no more than 90 days before the exam.
Show the FAA's words: The neurological evaluation
1. A current, detailed neurological evaluation that meets FAA Specifications for Neurologic Evaluation generated from a clinic visit with the treating neurologist (vascular neurologist preferred) no more than 90 days before the AME exam.
FAA source: Brain Bleed. FAA date 25 January 2023; checked by Crosscheck 14 October 2026.
Step 3: Imaging
Brain imaging, an MRI of the brain, and angiography.Brain imaging to verify the bleed has resolved
Brain imaging to verify the bleed has resolved, performed no more than 12 months before the exam.
MRI brain with hemosiderin-sensitive sequences
An MRI of the brain to include sequences sensitive to the presence of hemosiderin.
CTA, MRA or angiography
CT angiography (CTA) or MRA or angiography. The head is required, and the neck if clinically necessary.
Printed under item 4
- BOTH the interpretive report on paper and the imaging on CD in DICOM readable format, with a file named 'DICOMDIR' in the root directory of the CD-ROM
- The CD verified to display the images before sending
- The table suggests keeping a copy of all films, as a safeguard if lost in the mail
Show the FAA's words: Imaging
2. Brain imaging to verify bleed has resolved, performed no more than 12 months before the AME exam. If not already performed, a current test is required.
FAA source: Brain Bleed. FAA date 25 January 2023; checked by Crosscheck 14 October 2026.
3. MRI brain to include sequences sensitive to the presence of hemosiderin.
FAA source: Brain Bleed. FAA date 25 January 2023; checked by Crosscheck 14 October 2026.
4. CT angiography (CTA) or MRA or angiography. (Head required. Neck if clinically necessary)
FAA source: Brain Bleed. FAA date 25 January 2023; checked by Crosscheck 14 October 2026.
• Submit BOTH the interpretive report on paper and imaging on CD in DICOM readable format (there must be a file named 'DICOMDIR' in the root directory of the CD-ROM). Please verify the CD will display the images before sending. You may wish to retain a copy of all films as a safeguard if lost in the mail.
FAA source: Brain Bleed. FAA date 25 January 2023; checked by Crosscheck 14 October 2026.
Step 4: Hospital records
For each hospitalization related to this condition.For each hospitalization related to this condition.
For each hospitalization related to this condition.
Hospital records for each hospitalization related to this condition. They must include information on surgeries and procedures.
To include
- Admission history and physical (H&P)
- The EMS or ambulance run sheet, if applicable
- Hospital consultant reports, such as neurology, cardiology, internal medicine, or other specialists
- Hospital discharge summary
- Lab reports, including all drug or alcohol testing performed
- Operative or procedure reports
- Pathology reports
- Radiology reports: the interpretive reports AND IMAGES of all diagnostic imaging performed
Typically not sufficient as the discharge summary
- Not: The patient portal notes or after visit summary (AVS) that can be printed from an electronic medical record
Do not submit
- Not: Miscellaneous hospital records such as flowsheets, nursing notes, physician orders, or medication administration records
A large volume of records
- Recommended: bring them to the exam, so your AME can assist in determining what is miscellaneous and not needed by the FAA
Show the FAA's words: Hospital records
5. Hospital records for each hospitalization related to this condition. It must include information on surgeries and procedures. • Admission History and Physical (H&P); • Emergency Medical Services (EMS)/ambulance run sheet (if applicable); • Hospital consultant report(s) (such as neurology, cardiology, internal medicine, or other specialists); • Hospital discharge summary. (Typically, the patient portal notes or after visit summary (AVS) that can be printed from an electronic medical record are NOT sufficient for pilot medical certification purposes.); • Lab report(s) including all drug or alcohol testing performed; • Operative/procedure report(s); • Pathology report(s); and • Radiology reports. The interpretive report(s) AND IMAGES of all diagnostic imaging (CT Scan, MRI, X-ray, ultrasound, or others) performed.
FAA source: Brain Bleed. FAA date 25 January 2023; checked by Crosscheck 14 October 2026.
• DO NOT submit miscellaneous hospital records such as flowsheets, nursing notes, physician orders, or medication administration records.
FAA source: Brain Bleed. FAA date 25 January 2023; checked by Crosscheck 14 October 2026.
If the applicant has a large volume of records, it is recommended that they bring them to the exam so the AME can assist in determining what is miscellaneous and not needed by the FAA.
FAA source: Brain Bleed. FAA date 25 January 2023; checked by Crosscheck 14 October 2026.
Step 5: If the FAA asks for more
After review of the submitted information.May be required after review of the submitted information.
May be required after review of the submitted information.
A neuropsychological (NP) evaluation that meets that meets (as printed) FAA Specifications for Neuropsychological Evaluations for Potential Neurocognitive Impairment, from a clinic visit with your treating neuropsychologist.
Show the FAA's words: If the FAA asks for more
Note: After review of the submitted information, a Neuropsychological (NP) evaluation that meets that meets FAA Specifications for Neuropsychological Evaluations for Potential Neurocognitive Impairment from a clinic visit with the
treating neuropsychologist may be required
FAA source: Brain Bleed. FAA date 25 January 2023; checked by Crosscheck 14 October 2026.
Step 6: Trauma, a seizure, or a shunt
Where the table's notes point.The table's notes point to other sections of the FAA's guidance.
The table's notes
- If due to trauma, see the Traumatic Brain Injury section (subdural hematoma, epidural hematoma, or subarachnoid hemorrhage)
- If associated with a seizure, see that section. An additional recovery period and testing (such as EEG) may apply.
- If a shunt was placed, see the Hydrocephalus section
Show the FAA's words: Trauma, a seizure, or a shunt
(*If due to TRAUMA, See - Traumatic Brain Injury section, subdural hematoma, epidural hematoma, or subarachnoid hemorrhage.)
FAA source: Brain Bleed. FAA date 25 January 2023; checked by Crosscheck 14 October 2026.
If associated with a seizure – see that section. An additional recovery period and testing (such as EEG) may apply.
FAA source: Brain Bleed. FAA date 25 January 2023; checked by Crosscheck 14 October 2026.
If a shunt was placed – see the Hydrocephalus section.
FAA source: Brain Bleed. FAA date 25 January 2023; checked by Crosscheck 14 October 2026.
What the examiner checks
Row ADefers to the FAASpecial Issuance
After any required recovery period (two (2) years if a craniotomy was performed, one (1) year for a subarachnoid hemorrhage), the table lists what to submit for FAA review, and the examiner defers and submits the information to the FAA for a possible Special Issuance.
If the examiner defers
Show the FAA's words: what the examiner does on each row
- Row A · Special Issuance
Any history of a spontaneous intracranial hemorrhage not due to trauma. The table's examples may include a ruptured AVM, a subarachnoid hemorrhage (SAH), and a subdural or epidural hemorrhage. If due to trauma, it says see the Traumatic Brain Injury section. After any required recovery period (two (2) years if a craniotomy was performed, one (1) year for a subarachnoid hemorrhage), the table lists what to submit for FAA review, and the examiner defers and submits the information to the FAA for a possible Special Issuance.
A. Any history of a Spontaneous intracranial hemorrhage not due to trauma* (Examples may include ruptured AVM, Subarachnoid hemorrhage [SAH], Subdural, or epidural hemorrhage) (*If due to TRAUMA, See - Traumatic Brain Injury section, subdural hematoma, epidural hematoma, or subarachnoid hemorrhage.) … Required recovery periods: • If craniotomy performed: Two (2) years • Subarachnoid hemorrhage: One (1) year … After any required recovery period, submit the following for FAA review: … DEFER Submit information to the FAA for a possible Special Issuance
If the examiner defersSpecial Issuance
The table marks Row A, any history of a spontaneous intracranial hemorrhage not due to trauma, DEFER after any required recovery period.
What the FAA lists to send
- Item 1. A current, detailed neurological evaluation that meets FAA Specifications for Neurologic Evaluation, from a clinic visit with the treating neurologist (vascular neurologist preferred) no more than 90 days before the exam.
- Item 2. Brain imaging to verify the bleed has resolved, performed no more than 12 months before the exam; if not already performed, a current test.
- Item 3. An MRI of the brain to include sequences sensitive to the presence of hemosiderin.
- Item 4. CT angiography (CTA) or MRA or angiography, the head required and the neck if clinically necessary.
- Item 5. Hospital records for each hospitalization related to this condition, including information on surgeries and procedures, as the table lists.
Show the FAA's words: if the examiner defers
When the examiner defers
- Reason 1
The table marks Row A, any history of a spontaneous intracranial hemorrhage not due to trauma, DEFER after any required recovery period.
Any history of a Spontaneous intracranial hemorrhage not due to trauma* … After any required recovery period, submit the following for FAA review: … DEFER Submit information to the FAA for a possible Special Issuance
What the FAA lists to send
- Item 1
A current, detailed neurological evaluation that meets FAA Specifications for Neurologic Evaluation, from a clinic visit with the treating neurologist (vascular neurologist preferred) no more than 90 days before the exam.
1. A current, detailed neurological evaluation that meets FAA Specifications for Neurologic Evaluation generated from a clinic visit with the treating neurologist (vascular neurologist preferred) no more than 90 days before the AME exam.
- Item 2
Brain imaging to verify the bleed has resolved, performed no more than 12 months before the exam; if not already performed, a current test.
2. Brain imaging to verify bleed has resolved, performed no more than 12 months before the AME exam. If not already performed, a current test is required.
- Item 3
An MRI of the brain to include sequences sensitive to the presence of hemosiderin.
3. MRI brain to include sequences sensitive to the presence of hemosiderin.
- Item 4
CT angiography (CTA) or MRA or angiography, the head required and the neck if clinically necessary.
4. CT angiography (CTA) or MRA or angiography. (Head required. Neck if clinically necessary)
- Item 5
Hospital records for each hospitalization related to this condition, including information on surgeries and procedures, as the table lists.
5. Hospital records for each hospitalization related to this condition. It must include information on surgeries and procedures.
What a Special Issuance is
The Guide says an Authorization for Special Issuance, valid for a specified period, may be granted at the Federal Air Surgeon's discretion to a person who does not meet the established medical standards, if the person shows to the satisfaction of the Federal Air Surgeon that the duties authorized by the class of certificate applied for can be performed without endangering public safety during the period the Authorization would be in force.
How the FAA pathways workGood to know
Points from the FAA's own documents that are easy to miss.
A bleed due to trauma has its own section
This table is for a spontaneous intracranial hemorrhage not due to trauma. If due to trauma, its footnote says see the Traumatic Brain Injury section, and names subdural hematoma, epidural hematoma, or subarachnoid hemorrhage.
Show the FAA's words: good to know, 1
Any history of a Spontaneous intracranial hemorrhage not due to trauma* … (*If due to TRAUMA, See - Traumatic Brain Injury section, subdural hematoma, epidural hematoma, or subarachnoid hemorrhage.)
Two recovery periods
The table lists two required recovery periods, two (2) years if a craniotomy was performed and one (1) year for a subarachnoid hemorrhage, and then says after any required recovery period. It does not say which applies where both describe the case.
Show the FAA's words: good to know, 2
Required recovery periods: • If craniotomy performed: Two (2) years • Subarachnoid hemorrhage: One (1) year … After any required recovery period, submit the following for FAA review:
A ruptured AVM is named on two tables
This table lists a ruptured AVM among its examples of a spontaneous intracranial hemorrhage. The FAA's disposition table for an arteriovenous malformation (AVM) of the brain or spinal cord has a row that includes ruptured or repaired, with a list of its own. Neither table names the other, and this page does not choose between them.
Show the FAA's words: good to know, 3
Any history of a Spontaneous intracranial hemorrhage not due to trauma* (Examples may include ruptured AVM,
B. Brain or Spinal Cord Treated with embolization procedure Ruptured or repaired Submit the following for FAA review: 1. All items in Row A.
A neuropsychological evaluation may be required
The table's note says that after review of the submitted information, a neuropsychological (NP) evaluation from a clinic visit with the treating neuropsychologist may be required.
Show the FAA's words: good to know, 4
Note: After review of the submitted information, a Neuropsychological (NP) evaluation that meets that meets FAA Specifications for Neuropsychological Evaluations for Potential Neurocognitive Impairment from a clinic visit with the … treating neuropsychologist may be required
FAA sources
Every FAA document this page relies on, with the FAA's own date and the date Crosscheck last read it. The documents to print open at the FAA, so they are always the FAA's current ones.
This reports what the FAA has published. It is not medical advice, and it does not say how the FAA or an examiner will decide a case.