Position paper: ability to drive in cerebrovascular diseases

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Abstract

The regulations for fitness to drive after a cerebrovascular accident in the German Driving License Regulations (FeV) and the German Evaluation Guidelines for Driving Ability (BGL). are not up to date with the current medical knowledge and not consistent with regulations regarding cardiovascular diseases.

This position paper presented by six medical and neuropsychological societies in Germany provides a guideline for the assessment of driving ability after diagnosis of a cerebrovascular disease and addresses three major questions:

If there is a functional limitation, how can it be compensated for?

What is the risk of sudden loss of control while driving in the future?

Are there behavioral or personality changes or cognitive deficiencies interfering with safety while driving?

Recommendations for the assessment of driving ability in different cerebrovascular diseases are presented.

This article is a translation of the position paper published in Nervenarzt: Marx, P., Hamann, G.F., Busse, O. et al. Nervenarzt 90(4): 388–398.

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Most cited references 64

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Heart Disease and Stroke Statistics—2017 Update: A Report From the American Heart Association

Emelia Benjamin, Michael Blaha, Stephanie Chiuve … (2017)

Circulation, 135(10)

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Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment.

H P Adams, B H Bendixen, L J Kappelle … (1993)

The etiology of ischemic stroke affects prognosis, outcome, and management. Trials of therapies for patients with acute stroke should include measurements of responses as influenced by subtype of ischemic stroke. A system for categorization of subtypes of ischemic stroke mainly based on etiology has been developed for the Trial of Org 10172 in Acute Stroke Treatment (TOAST). A classification of subtypes was prepared using clinical features and the results of ancillary diagnostic studies. "Possible" and "probable" diagnoses can be made based on the physician's certainty of diagnosis. The usefulness and interrater agreement of the classification were tested by two neurologists who had not participated in the writing of the criteria. The neurologists independently used the TOAST classification system in their bedside evaluation of 20 patients, first based only on clinical features and then after reviewing the results of diagnostic tests. The TOAST classification denotes five subtypes of ischemic stroke: 1) large-artery atherosclerosis, 2) cardioembolism, 3) small-vessel occlusion, 4) stroke of other determined etiology, and 5) stroke of undetermined etiology. Using this rating system, interphysician agreement was very high. The two physicians disagreed in only one patient. They were both able to reach a specific etiologic diagnosis in 11 patients, whereas the cause of stroke was not determined in nine. The TOAST stroke subtype classification system is easy to use and has good interobserver agreement. This system should allow investigators to report responses to treatment among important subgroups of patients with ischemic stroke. Clinical trials testing treatments for acute ischemic stroke should include similar methods to diagnose subtypes of stroke.

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European Stroke Organization Guidelines for the Management of Intracranial Aneurysms and Subarachnoid Haemorrhage

Thorsten Steiner, Seppo Juvela, Andreas Unterberg … (2013)

Background: Intracranial aneurysm with and without subarachnoid haemorrhage (SAH) is a relevant health problem: The overall incidence is about 9 per 100,000 with a wide range, in some countries up to 20 per 100,000. Mortality rate with conservative treatment within the first months is 50–60%. About one third of patients left with an untreated aneurysm will die from recurrent bleeding within 6 months after recovering from the first bleeding. The prognosis is further influenced by vasospasm, hydrocephalus, delayed ischaemic deficit and other complications. The aim of these guidelines is to provide comprehensive recommendations on the management of SAH with and without aneurysm as well as on unruptured intracranial aneurysm. Methods: We performed an extensive literature search from 1960 to 2011 using Medline and Embase. Members of the writing group met in person and by teleconferences to discuss recommendations. Search results were graded according to the criteria of the European Federation of Neurological Societies. Members of the Guidelines Committee of the European Stroke Organization reviewed the guidelines. Results: These guidelines provide evidence-based information on epidemiology, risk factors and prognosis of SAH and recommendations on diagnostic and therapeutic methods of both ruptured and unruptured intracranial aneurysms. Several risk factors of aneurysm growth and rupture have been identified. We provide recommendations on diagnostic work up, monitoring and general management (blood pressure, blood glucose, temperature, thromboprophylaxis, antiepileptic treatment, use of steroids). Specific therapeutic interventions consider timing of procedures, clipping and coiling. Complications such as hydrocephalus, vasospasm and delayed ischaemic deficit were covered. We also thought to add recommendations on SAH without aneurysm and on unruptured aneurysms. Conclusion: Ruptured intracranial aneurysm with a high rate of subsequent complications is a serious disease needing prompt treatment in centres having high quality of experience of treatment for these patients. These guidelines provide practical, evidence-based advice for the management of patients with intracranial aneurysm with or without rupture. Applying these measures can improve the prognosis of SAH.

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Author and article information

Contributors

Peter Marx:

ORCID: http://orcid.org/0000-0002-0451-3044

peter.marx@charite.de

Gerhard Hamann: gerhard.hamann@bkh-guenzburg.de

Otto Busse: busse@dsg-berlin.org

Thomas Mokrusch: mokrusch@mac.com

Hendrik Niemann: niemann@sachsenklinik.de

Hartmut Vatter: Hartmut.Vatter@ukbonn.de

Bernhard Widder: bernhard.widder@t-online.de

Journal

Journal ID (nlm-ta): Neurol Res Pract

Journal ID (iso-abbrev): Neurol Res Pract

Title: Neurological Research and Practice

Publisher: BioMed Central (London )

ISSN (Electronic): 2524-3489

Publication date (Electronic): 23 October 2019

Publication date PMC-release: 23 October 2019

Publication date Collection: 2019

Volume: 1

Electronic Location Identifier: 37

Affiliations

[1 ]ISNI 0000 0001 2218 4662, GRID grid.6363.0, Department of Neurology, Campus Benjamin Franklin, , Charitè Universtitätsmedizin Berlin, ; Terrassenstr. 45, 14129 Berlin, Germany

[2 ]Department of Neurology, Bezirkskrankenhaus Günzburg, Günzburg, Germany

[3 ]Deutsche Schlaganfallgesellschaft, Berlin, Germany

[4 ]Department of Neurological Rehabilitation, MediClin Hedon Klinik Lingen, Lingen, Germany

[5 ]NRZ Center of Neurological Rehabilitation, Leipzig, Germany

[6 ]ISNI 0000 0001 2240 3300, GRID grid.10388.32, Department of Neusosurgery, , Friedrich-Wilhelm-University Bonn, ; Bonn, Germany

[7 ]Institute of medico-legal Assessment, Bezirkskrankenhaus Günzburg, Günzburg, Germany

Author information

Peter Marx http://orcid.org/0000-0002-0451-3044

Article

Publisher ID: 43

DOI: 10.1186/s42466-019-0043-z

PMC ID: 7650052

SO-VID: d59b3396-98d0-432a-9872-919f5d2ed8d9

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 14 February 2019

Date accepted : 30 September 2019

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Keywords: stroke,transient ischemic attack,intracerebral bleeding,subarachnoid bleeding ,informed consent,fitness to drive

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Keywords: stroke, transient ischemic attack, intracerebral bleeding, subarachnoid bleeding , informed consent, fitness to drive

Position paper: ability to drive in cerebrovascular diseases

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Most cited references 64

Heart Disease and Stroke Statistics—2017 Update: A Report From the American Heart Association

Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment.

European Stroke Organization Guidelines for the Management of Intracranial Aneurysms and Subarachnoid Haemorrhage

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