Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Cerebral Aneurysm (Non-Ruptured)


Related Terms

  • Acquired Brain Aneurysm
  • Arteriosclerotic Brain Aneurysm
  • Berry Aneurysm
  • Brain Aneurysm
  • Dissecting Aneurysm
  • Fusiform Aneurysm
  • Saccular Aneurysm
  • Subarachnoid Hemorrhage

Differential Diagnosis

Specialists

  • Neurologist
  • Neurosurgeon
  • Thoracic Surgeon

Comorbid Conditions

  • Alpha-glucosidase deficiency
  • Cardiovascular disease
  • Hereditary hemorrhagic telangiectasia
  • Hypertension
  • Neurofibromatosis type l
  • Noonan's syndrome
  • Polycystic kidney disease
  • Pseudoxanthoma elasticum
  • Tuberous sclerosis

Factors Influencing Duration

Factors that may influence the length of disability include the age of the individual, the location and size of the aneurysm, the point at which diagnosis is made, the type of surgical procedure used to repair the aneurysm, the individual's response to treatment, and whether the aneurysm ruptures.

Medical Codes

ICD-9-CM:
437.3 - Cerebrovascular Disease, Other and Ill Defined; Cerebral Aneurysm, Non-ruptured

Overview

© Reed Group
A cerebral aneurysm (CA) is a dilatation in the wall of a blood vessel in the brain; it refers to a localized weakness in the wall of an artery or vein resulting in a ballooning (dilation) of the vessel. There are three categories of aneurysm: saccular, fusiform, and dissecting. The first two describe the shape of the aneurysm, and the last indicates that blood has accumulated in the wall of the vessel. The most common form is a small saccular aneurysm called a berry aneurysm. Clusters of berry aneurysms are often noted in the large arteries at the base of the brain but can occur in any area of the brain. Other types of CA may involve dilation of the entire circumference of the blood vessel in an area or may appear as a ballooning out of part of a blood vessel. Although CAs can occur in any blood vessel of the brain, most of the time they are found on specific branches of the main arterial circulation supplying the head and neck.

Most CAs are about the size of a pea, although they can be as small as a pinhead or as large as an orange. Not all aneurysms grow. The ones that do grow do so at varying rates; the average growth rate for an aneurysm of 5 mm is about 0.15 mm per year (Jou).

Incidence and Prevalence: About 5% to 10% of the population has an unruptured CA (Caranci).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Cerebral aneurysms of various sizes may affect up to 10% of the population, but only a small fraction will rupture. Early retrospective studies suggested that CA size may be the main predictor of rupture, with annual rupture rates of 3.3% per year for those 10 mm to 15 mm, 5.6% per year for those 16 mm to 25 mm, and 8.9% per year for those larger than 25 mm, but the causes of rupture are still under intense study. Women are more likely than men to have an unruptured CA. Genetics plays an important role in the cause of CAs (Caranci). Blacks are twice as likely to have a CA as are Caucasians (Krischek).

The four most important risk factors for CA rupture are smoking, family history (increases with number of first-degree relatives affected), hypercholesterolemia, and high blood pressure (hypertension). Excessive alcohol use and lack of physical exercise are also risk factors (Vlak).

CAs may develop from blood vessel wall weakness at birth (congenital defect), a degenerative process, or a combination of the two. For example, should an individual have a congenitally weak arterial wall and later develop a buildup of fatty cells within the arteries (atherosclerosis), the resulting hypertension could cause an aneurysm to develop that may later rupture. Other causes of CA are head trauma or a tumor. Individuals who may be more at risk for developing CA are those with a history of hypertension, high blood fats (hyperlipidemia), cerebrovascular disease, cardiovascular disease, or diabetes mellitus. Berry aneurysm is also associated with polycystic kidney disease and malformation of the aorta that causes narrowing of that vessel (coarctation).

Source: Medical Disability Advisor



Diagnosis

History: It is possible that the individual will have no symptoms (asymptomatic) until the aneurysm ruptures and complications develop. Bleeding is the most common cause of symptoms, and subarachnoid hemorrhage (SAH) is the most usual type of bleed. Those who witness the individual with a CA rupture might describe behavioral changes, an altered ability to speak or move, inappropriate answers to questions, mental "fogginess," or sudden loss of consciousness. A report of "the worst headache of one's life" warrants a workup, including a computed tomography (CT) scan and lumbar puncture. Often the lumbar puncture fluid must be centrifuged to assess for RBC, since it is often contaminated with venous blood from the technique. Weakness, numbness, or other nerve function loss may develop because of pressure from the CA on adjacent brain tissue, or because arterial spasm has caused reduced blood flow to other blood vessels near a ruptured aneurysm.

The individual may report a history of head trauma or an extremely severe headache that came on suddenly, accompanied by nausea and vomiting, visual changes, drooping eyelids, stiff neck, a feeling of lethargy or sleepiness, irritability, and impaired speech.

Physical exam: Brain function (neurological) examination may reveal weakness in muscle tone, and decreased ability to move. The increased pressure within the brain may result in small hemorrhages appearing on the retina of the eye, and the optic nerve itself may swell (optic nerve papilledema). Additionally, the eyes may not move appropriately; the pupils may not dilate, constrict equally, or react to light; and the lids may droop. The individual will commonly exhibit hypertension.

Tests: Cerebral angiography, in which a catheter is inserted into an artery, contrast medium injected, and the unruptured aneurysm visualized via fluoroscopy, is often the test of choice to diagnose a CA. Magnetic resonance angiography (MRA) is a less invasive method using magnetic resonance imaging (MRI) technology and contrast medium to visualize the blood vessels. It is usually the first option before attempting the more risky traditional angiography procedure. CT of the head indicates if bleeding (hemorrhage) has occurred but does not always locate the aneurysm. If the CT does not show any bleeding when bleeding is suspected, a lumbar puncture may be done to check for blood in the cerebrospinal fluid (CSF) to determine whether pressure inside the skull (intracranial pressure) has increased. A complete blood count (CBC) to determine if there is internal bleeding, measuring arterial blood gases (ABGs) to determine if the blood is being sufficiently oxygenated, and coagulation studies to determine if the blood is clotting appropriately will also be done.

Source: Medical Disability Advisor



Treatment

Prior to CA rupture, treatment focuses on reducing the risk of rupture. Symptoms of a CA generally do not appear until it has begun to bleed (hemorrhage) and at that point, it is a medical emergency. Treatment then focuses on controlling symptoms to prevent further bleeding or the development of potentially serious complications.

The primary treatment for CA is a surgical procedure known as clipping. The skull is opened, and the area between the normal blood vessel and the aneurysm (neck of the aneurysm) is identified. Once this weakened area is located, the surgeon places a clip (or clamp or suture) across it to prevent blood flow through the aneurysm.

If the individual is not a candidate for clipping surgery, an endovascular or embolization procedure may be done. The surgeon will insert a catheter into the cerebral artery through an artery in the upper thigh (femoral artery). While it is viewed on x-ray, the catheter is threaded into the aneurysm. A silicone-like substance or small coils are then injected to fill the aneurysm (coiling), sealing it off. The lining of the blood vessel will eventually grow over the neck of the aneurysm. If surgery is not feasible because of either the location or size of the aneurysm or the individual's medical condition, treatment consists of conservative measures. This includes complete bed rest in a quiet, darkened room with limited visitation. A sedative to minimize stress, a narcotic analgesic for pain relief, and, if necessary, a medication to prevent seizures (anti-epileptic) may be prescribed. The individual is advised to avoid aspirin, coffee, and stimulants.

In case of hypertension, the individual will receive an antihypertensive drug to lower blood pressure. The physician may order a calcium channel blocker to control blood vessel spasm that could precipitate a rupture. Additionally, corticosteroids are administered, and fluid intake is restricted to reduce swelling (edema). The individual will be positioned at a 45° angle, and an ice bag may be applied to relieve headaches. Cooling measures may also be instituted to diminish blood flow to the brain and reduce the risk of aneurysm rupture.

Controversies in the neurosurgical management of CA include the argument over early versus late treatment and the use of the calcium channel blocker nimodipine.

Source: Medical Disability Advisor



Prognosis

The outcome is related to the location and size of the CA. Individuals with small aneurysms that never rupture may remain symptom-free and the aneurysms may go undetected. In fact, most CAs remain asymptomatic throughout life. However, as an aneurysm enlarges, the risk of rupture increases significantly (Caranci).

The mortality rate for SAH following CA rupture is about 50% for people who make it to the hospital in time (van Gijn). Among those individuals who survive SAH at least 3 months, the risk of complications and death is increased. The risk of all-cause death, vascular death, and fatal and nonfatal vascular disease is significantly increased among those with previous SAH (Nieuwkamp). The National Institutes of Health (NIH) report that about 40% of those whose aneurysms have ruptured do not survive the first 24 hours, and that another 25% die from complications in the next 6 months.

The prognosis depends on the severity of the hemorrhage with rupture. The larger the hematoma, the worse the outcome is. Size of the hematoma can predict 30-day mortality as well as functional outcome. Location of the hematoma is also an important indicator of outcome (Brouwers).

Clipping or coiling performed before a CA ruptures decreases the risk of SAH from rupture. After rupture, successful clipping and coiling reduces the risk of rebleeding. Rebleeding occurs in about a third of individuals left untreated (Steiner). Each episode of rebleeding has a mortality and morbidity rate of 80% (van Gijn). If the clipping procedure fails, the risk of rupture or rebleeding remains.

Clipping and coiling is recommended for individuals with small aneurysms less than 10 mm under the age of 67 and 77, respectively. With unruptured anterior circulation CAs between 7 mm and 12 mm, clipping and coiling should be considered for individuals under the age of 61 and 70, respectively. With unruptured posterior circulation CAs between 7 mm and 12mm, clipping and coiling should be considered for individuals under the age of 78 and 89, respectively. (Lawson). After these ages the risk of complications and death from the surgery outweighs the risk of the natural history of the untreated aneurysm.

The risk of morbidity from clipping is somewhat higher than from coiling (4.75% vs. 2.16%). Surgical centers with high quality experience in treating this disorder have better results compared to centers with less experience (Steiner).

Source: Medical Disability Advisor



Rehabilitation

A nonruptured CA generally does not require rehabilitation, since the individual has no symptoms. If a rupture occurs, depending on the location, size, and extent of bleeding, rehabilitation requirements will vary from relearning basic skills to extensive relearning of many brain functions.

Source: Medical Disability Advisor



Complications

Factors that may complicate a cerebral aneurysm include SAH; neurologic defects such as partial paralysis, loss of sensation, and speech loss or impairment; visual problems; seizures; stroke or additional bleeding; an abnormal accumulation of cerebral spinal fluid within the cranial cavity (hydrocephalus); and death.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Strenuous physical activity puts an individual at greater risk for rupture of an aneurysm, so permanent reassignment may be required for those who do heavy physical labor. A sedentary environment that is not stressful may be warranted.

Risk: No job would place an individual at risk after a successful repair.

Capacity: Capacity would be unaffected after a successful repair. If the individual has an nonruptured CA, blood pressure monitoring while at work may be necessary when adding medications.

Tolerance: Tolerance would be unaffected after a successful repair.

Source: Medical Disability Advisor



Maximum Medical Improvement

1 day.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Does individual report the "worst headache of my life"? Prior history of headaches? Nausea and vomiting?
  • Does individual smoke? Have hypertension? Hypercholesterolemia? Hyperlipidemia? Diabetes? Family history of CA?
  • Is exam suggestive of meningeal irritation?
  • What is the size of individual's aneurysm?
  • If CA rupture occurred, was it witnessed? If so, what did the observer see?
  • Does individual have a history of head injury?
  • Was individual's brain function abnormal? If so, to what extent?
  • Did individual have papilledema?
  • Was an angiogram done? CT? What were the results?
  • Was a lumbar puncture done?
  • Did individual have a CBC and coagulation studies? What were the results?

Regarding treatment:

  • Did individual have surgical clipping of the aneurysm?
  • If individual was not a candidate for clipping, was an endovascular or embolization procedure (coiling) performed? If not, what is the response to conservative treatment?
  • Is individual on medication to reduce stress? Prevent seizures? Lower blood pressure?
  • Is individual on a calcium channel blocker to control blood vessel spasm? Corticosteroids to reduce brain swelling?
  • Is individual engaging in physical exercise? Reducing alcohol intake?

Regarding prognosis:

  • Have any complications developed? What were they?
  • Does individual have hypertension or cardiovascular disease?

Source: Medical Disability Advisor



References

Cited

Brouwers, H. B. , and J. N. Goldstein. "Therapeutic Strategies in Acute Intracerebral Hemorrhage." Neurotherapeutics 9 (2012): 87-98.

Caranci, F. , et al. "Epidemiology and Genetics of Intracranial Aneurysms." European Journal of Radiology 82 (2013): 1598-1605.

Jasmin, Luc. "Aneurysm in the Brain." MedlinePlus. 26 Feb. 2014. National Library of Medicine. 8 May 2014 <http://www.nlm.nih.gov/medlineplus/ency/article/001414.htm>.

Jou, L. D. , and M. E. Mawad. "Growth Rate and Rupture Rate of Unruptured Intracranial Aneurysms: A Population Approach." Biomedical Engineering Online 8 11 (2009): None-None.

Krischek, B. , and I. Inoue. "The Genetics of Intracranial Aneurysms." Journal of Human Genetics 51 (2006): 587-594.

Lawson, Matthew F. , et al. "Treatment Benefit of Clipping or Coiling Small Unruptured Intracranial Aneurysms." Congress of Neurological Surgeons. 16 Jun. 2014 <http://w3.cns.org/dp/2011CNS/913.pdf>.

Liebeskind, David S. "Cerebral Aneurysms." eMedicine. Eds. Helmi L. Lutsep, et al. 1 Apr. 2014. Medscape. 8 May 2014 <http://emedicine.medscape.com/article/1161518-overview>.

Moses, Scott. "Cerebral Aneurysm." Family Practice Notebook. 29 Jan. 2013. 8 May 2014 <http://www.fpnotebook.com/legacy/Neuro/CV/CrbrlAnrysm.htm>.

Nieuwkamp, D. J. , et al. "Excess Mortality and Cardiovascular Events in Patients Surviving Subarachnoid Hemorrhage: A Nationwide Study in Sweden." Stroke 42 (2011): 902-907.

Steiner, T. , et al. "European Stroke Organization Guidelines for the Management of Intracranial Aneurysms and Subarachnoid Haemorrhage." Cerebrovascular Diseases 35 (2013): 93-112.

van Gijn, J. , R. S. Kerr, and G. J. Rinkel. "Subarachnoid Haemorrhage." Lancet 369 (2007): 306-318.

Vlak, M. H. , et al. "Prevalence of Unruptured Intracranial Aneurysms, with Emphasis on Sex, Age, Comorbidity, Country, and Time Period: A Systematic Review and Meta-Analysis." Lancet Neurology 10 (2011): 626-636.

Source: Medical Disability Advisor






Feedback
Send us comments, suggestions, corrections, or anything you would like us to hear. If you are not logged in, you must include your email address, in order for us to respond. We cannot, unfortunately, respond to every comment. If you are seeking medical advice, please contact your physician. Thank you!
Send this comment to:
Sales Customer Support Content Development
 
This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is published with the understanding that the author, editors, and publisher are not engaged in rendering medical, legal, accounting or other professional service. If medical, legal, or other expert assistance is required, the service of a competent professional should be sought. We are unable to respond to requests for advice. Any Sales inquiries should include an email address or other means of communication.