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

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
443.2 - Arterial Dissection, Other

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 a vein or artery 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 cerebral aneurysms 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 cerebral aneurysms 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 aneurysms are about the size of a pea, although they can be as small as a pinhead or as large as an orange. Aneurysms tend to grow at a rate of one-eighth to one-quarter inch per year, with the increasing likelihood of rupture as the aneurysm expands. As the aneurysm grows, it puts mounting pressure against neighboring brain tissue and can result in potentially lethal complications.

Cerebral aneurysms develop from either a vessel wall weakness at birth (congenital defect), a degenerative process, or a combination of the 2. 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 high blood pressure (hypertension) could cause an aneurysm to develop that may later rupture. Other causes of cerebral aneurysm are head trauma or a tumor. Individuals who may be more at risk for developing cerebral aneurysm are those with a history of hypertension, high blood fats (hyperlipemia), 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).

Incidence and Prevalence: New cases of cerebral aneurysms that have ruptured occur in approximately 10 to 12 of 100,000 individuals yearly ("Aneurysm"; Liebeskind).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Cerebral aneurysms more commonly occur in women than in men, but some type of aneurysm occurs in approximately 6% of the population at large. The risk rises to 9% when there is a history of aneurysm in more than one family member (Moses). In 15% to 20% of cases, cerebral aneurysms are multiple, but when there are more than three, the occurrence in women compared to men jumps from 5:1, to 11:1 (Soliman). Blacks are at twice the risk of CA as the rest of the population. The risk of CA rises with age, peaking at 55 to 60, and is unusual in infants and children (Liebeskind). Lifestyle habits such as alcohol abuse, smoking, use of oral contraceptives, and cocaine use elevates the risk of CA.

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 is the most usual type of bleed. Those who witness the individual with a rupture might describe behavioral changes, changes in the ability to speak or move, mental "fogginess," or sudden loss of consciousness. A report of "the worst headache of one's life" warrants a workup, including a 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 aneurysm 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, or impaired speech.

Physical exam: Brain function (neurological) examination may reveal inappropriate answers to questions, 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 patient will commonly exhibit a general rise in blood pressure (hypertension).

Tests: Cerebral angiography, in which a catheter is inserted into an artery, contrast medium injected, and the unruptured aneurysm visualized via x-ray fluoroscopy, is often the test of choice to diagnose an aneurysm. Magnetic resonance angiography (MRA) is a less invasive method using MRI technology and contrast medium to visualize the blood vessels. It is usually the first option before attempting the more risky 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 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 rupture, treatment focuses on reducing the risk of rupture. Symptoms of a cerebral aneurysm 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 cerebral aneurysm 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, endovascular or embolization surgery 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, 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 patient will receive an antihypertensive drug to lower blood pressure. The healthcare provider may order a calcium channel blocker to control blood vessel spasms 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-degree 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 aneurysm. Small aneurysms that never rupture may go undetected with the consequence that the individual may remain symptom-free. In fact, most aneurysms remain asymptomatic throughout life. However, as an aneurysm enlarges, the risk of rupture increases significantly. When an aneurysm ruptures, 25% of individuals die within 24 hours, and an additional 25% will die within 3 months. More than 50% of the remaining individuals will most likely have some type of permanent neurological impairment ("Aneurysm").

With early detection, the outcome is usually good after aneurysm clipping. Individuals who cannot undergo surgical clipping and require endovascular surgery should also have good prospects, but their prognosis will depend on the reason(s) why surgical clipping of the aneurysm posed a risk.

Source: Medical Disability Advisor



Rehabilitation

A nonruptured cerebral aneurysm 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 subarachnoid hemorrhage; 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.

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?
  • Is exam suggestive of meningeal irritation?
  • What is the size of individual's aneurysm?
  • Was individual's "rupture" 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 endovascular or embolization surgery 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 spasms? Corticosteroids to reduce brain swelling?

Regarding prognosis:

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

Source: Medical Disability Advisor



References

Cited

"Aneurysm in the Brain." MedlinePlus. 28 Oct. 2004. National Library of Medicine. 27 Dec. 2004 <http://www.nlm.nih.gov/medlineplus/ency/article/001414.htm>.

Liebeskind, David S. "Cerebral Aneurysms." eMedicine. Eds. Draga Jichici, et al. 8 Jun. 2004. Medscape. 27 Dec. 2004 <http://emedicine.com/NEURO/topic503.htm>.

Moses, Scott. "Cerebral Aneurysm." Family Practice Notebook. 25 Oct. 2004. 27 Dec. 2004 <http://www.fpnotebook.com/NEU29.htm>.

Soliman, Emad. "Cerebral Aneurysm." eMedicine. Eds. Paul L. Penar, et al. 8 Jun. 2004. Medscape. 22 Oct. 2004 <http://emedicine.com/med/topic3468.htm>.

Source: Medical Disability Advisor






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