Subarachnoid hemorrhage

Hunt and Hess Grading Scale[92]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.

Prognosis on Admission of Aneurysmal Subarachnoid Haemorrhage (PAASH)[93]Takagi K, Tamura A, Nakagomi T, et al. How should a subarachnoid hemorrhage grading scale be determined? A combinatorial approach based solely on the Glasgow Coma Scale. J Neurosurg. 1999 Apr;90(4):680-7. http://www.ncbi.nlm.nih.gov/pubmed/10193613?tool=bestpractice.com

Grade I: GCS score 15.

Grade II: GCS score 11-14.

Grade III: GCS score 8-10.

Grade IV: GCS score 4-7.

Grade V: GCS score 3.

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 subarachnoid hemorrhage (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.