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Optimal management of subarachnoid hemorrhage requires prognostic understanding and effective communication with neurology and neurosurgical consultants, as well as the patient and their family members.
It is therefore often helpful to utilize and reference the widely recognized Hunt and Hess Scale in grading symptoms of ruptured cerebral aneurysm and subarachnoid hemorrhage severity:
- Grade 1: Asymptomatic; or minimal headache with slight nuchal rigidity. Approximate survival rate (ASR) 70%.
- Grade 2: Moderate to severe headache; nuchal rigidity; no neurologic deficit except cranial nerve palsy. ASR 60%.
- Grade 3: Drowsy; minimal neurologic deficit. ASR 50%.
- Grade 4: Stuporous; moderate to severe hemiparesis; possible early decerebrate rigidity and vegetative abnormality. ASR 20%.
- Grade 5: Deep coma; decerebrate rigidity; moribund. ASR 10%.
- Grade 6: Death; brain dead.
For your convenience, an online Hunt and Hess Scale calculating tool can be found at:
http://www.mdcalc.com/hunt-and-hess-classification-of-subarachnoid-hemorrhage-sah
References
The following historical references retrieved from http://www.strokecenter.org/trials/scales/hunt_hess.html:
- Hunt WE, Hess RM. “Surgical risk as related to time of intervention in the repair of intracranial aneurysms.” Journal of Neurosurgery 1968 Jan;28(1):14-20.
- Hunt WE, Meagher JN, Hess RM. “Intracranial aneurysm. A nine-year study.”Ohio State Medical Journal 1966 Nov;62(11):1168-71.