Subarachnoid hemorrhage

Hunt and Hess Grading Scale[93]Hunt WE, Hess RM. Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg. 1968 Jan;28(1):14-20.

Grade I: asymptomatic or minimal headache and slight nuchal rigidity (survival 70%).

Grade II: moderate to severe headache, nuchal rigidity, and no neurologic deficits other than cranial nerve palsy (survival 60%).

Grade III: drowsiness, confusion, or mild focal deficits (survival 50%).

Grade IV: stupor, moderate to severe hemiparesis, possibly early decerebrate rigidity, and vegetative disturbances (survival 20%).

Grade V: deep coma, decerebrate rigidity, and moribund appearance (survival 10%).

World Federation of Neurological Surgeons Grading Scale (adapted from Suarez et al)[1]Suarez JI, Tarr RW, Selman WR. Aneurysmal subarachnoid hemorrhage. N Engl J Med. 2006 Jan 26;354(4):387-96.

Grade I: Glasgow Coma Scale (GCS) score 15. Motor deficit absent.

Grade II: GCS score 14-13. Motor deficit absent.

Grade III: GCS score 14-13. Motor deficit present.

Grade IV: GCS score 12-7. Motor deficit present or absent.

Grade V: GCS score 6-3. Motor deficit present or absent.

Modified Fisher Grading Scale[94]Frontera JA, Claassen J, Schmidt JM, et al. Prediction of symptomatic vasospasm after subarachnoid hemorrhage: the modified fisher scale. Neurosurgery. 2006 Jul;59(1):21-7; discussion 21-7. http://www.ncbi.nlm.nih.gov/pubmed/16823296?tool=bestpractice.com ​​

The Modified Fisher and the Fisher grading scales predict the risk of vasospasm and delayed cerebral ischemia in SAH based on the amount and type of blood on computed tomography.[94]Frontera JA, Claassen J, Schmidt JM, et al. Prediction of symptomatic vasospasm after subarachnoid hemorrhage: the modified fisher scale. Neurosurgery. 2006 Jul;59(1):21-7; discussion 21-7. http://www.ncbi.nlm.nih.gov/pubmed/16823296?tool=bestpractice.com ​[95]Fisher CM, Kistler JP, Davis JM. Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery. 1980 Jan;6(1):1-9. http://www.ncbi.nlm.nih.gov/pubmed/7354892?tool=bestpractice.com ​​ The modified version improves the original by incorporating the presence of intraventricular hemorrhage (IVH).​[94]Frontera JA, Claassen J, Schmidt JM, et al. Prediction of symptomatic vasospasm after subarachnoid hemorrhage: the modified fisher scale. Neurosurgery. 2006 Jul;59(1):21-7; discussion 21-7. http://www.ncbi.nlm.nih.gov/pubmed/16823296?tool=bestpractice.com

Grade I: focal or diffuse thin SAH, no IVH.

Grade II: focal or diffuse thin SAH, with IVH.

Grade III: thick SAH present, no IVH.

Grade IV: thick SAH present, with IVH.