A driver who had an isolated TIA 6 months ago presents with normal exam results. What should the examiner decide?

In this scenario, a transient ischemic attack (TIA) historically denotes a temporary period of symptoms similar to those of a stroke. Although the driver presents with a normal examination and it has been six months since the event, the implications of a TIA are significant in assessing the driver's fitness for commercial driving.

The guidelines advocate for a cautious approach as a TIA is a strong risk factor for a subsequent stroke, which could lead to sudden incapacitation while operating a vehicle. Safety is paramount in the context of commercial driving, wherein the driver must be able to maintain full cognitive and physical control at all times. Therefore, until the risk factors associated with the TIA are thoroughly evaluated and managed, and the individual has had a longer observation period without any neurological events, it would be prudent for the examiner to disqualify the driver.

This decision prioritizes the safety of the driver, passengers, and the public, aligning with the regulatory responsibilities of the medical examiner in ensuring that drivers are fit to operate their vehicles. Other options would allow for certification based on current normal examination results but do not fully consider the implications of the previous TIA and the potential risks involved.