Cerebrovascular disease
This group of conditions includes strokes arising from occlusive vascular disease (cerebral thrombosis), spontaneous intracerebral haemorrhage and transient ischaemic attacks. People who have suffered strokes are at increased risk of a second attack that may render them unconscious or incapable of handling a motor vehicle. The residual effects of stroke in terms of hemiplegia or other neurological sequelae such as perceptual and visual problems, as well as effects on cognition, are often sufficient to render an individual unfit to drive. Transient ischaemic attacks may also render an individual unconscious or unable to control a vehicle.
Cerebrovascular accident (CVA)
Where there is doubt about fitness to drive in terms of residual disability in any area, a driving assessment by an occupational therapist trained to provide off-road and/or on-road assessments should be undertaken.
Medical standards for individuals applying for or renewing a class 1 or class 6 licence and/or a D, F, R, T or W endorsement.
When driving should cease:
An individual should not drive until clinical recovery is complete, with no significant residual disability likely to compromise safety. However, this period should not be less than one month from the event.
Individuals with the presence of homonymous hemianopia are generally considered permanently unfit to drive. The presence of other disorders such as ataxia, vertigo and diplopia will also generally make individuals permanently unfit to drive unless there is a full level of functional recovery.
The presence of epilepsy-associated significant cardiovascular disorders and recurrent transient ischaemic attacks following a stroke will generally result in individuals being considered unfit to drive.
When driving may resume or may occur:
Driving may resume when there has been satisfactory clinical recovery, providing that there is no residual limb disability that cannot be accommodated by appropriate vehicle modifications, and there is no evidence of cerebral damage resulting in cognitive defects, reduced reaction times, perceptual difficulties and visual problems such as homonymous field defects and/or hemispatial neglect.
Individuals are generally considered unfit to drive where there is the presence of epilepsy, associated significant cardiovascular disorders and recurrent transient ischaemic attacks following a stroke. In exceptional circumstances, the Agency may consider granting a licence after 12 months if a supporting specialist physician or neurologist's report is provided with the application. If licences are granted, the Agency may impose licence conditions for regular medical assessment of fitness to drive.
We strongly advise that, wherever there is doubt about fitness to drive in terms of cognitive or physical defects, an occupational therapist with training in driving assessment should make a full assessment. In many cases, it may be possible to allow a return to driving after suitable vehicle modifications have been made.
Medical standards for individuals applying for or renewing a class 2, 3, 4 or 5 licence and/or a P, V, I or O endorsement
When driving should cease:
Licences are generally not granted to applicants with a history of cerebrovascular accident. Individuals who have suffered from a cerebrovascular event are generally considered permanently unfit to drive unless sound reasons exist for a less stringent approach. The presence of secondary epilepsy will generally result in individuals being considered permanently unfit to drive.
When driving may resume or may occur:
Under some circumstances, a licence may be granted with conditions to existing holders of these classes and/or endorsement types. If there has been a full and complete recovery with no suggestion of recurrence over a period of three years, the possibility of a return to driving may be considered by the Agency (via the Chief Medical Adviser). A supporting specialist physician or neurologist's report will be required.
