ADD-ONS / SCALES
Subarachnoid hemorrhage scales
Created 25.09.2019, last update 06.10.2021
Hunt-Hess score
- a graded scale used to predict the mortality rate based on the clinical features seen in a patient presenting with an aneurysmal SAH
- the lower the grade, the better the prognosis
- grades I-III are associated with a favorable outcome, these patients are candidates for early surgical/endovascular treatment
- grades IV and V carry are associated with a poor prognosis; these patients require stabilization and improvement to grade III prior to surgery. Some recommend more aggressive management of patients with poor clinical grade
Hunt-Hess grading system |
||
Grade | Description |
Probability of severe morbidity/ mortality
|
0 |
unruptured aneurysm – incidental finding
|
– |
1 |
asymptomatic
mild headache and/or mild nuchal rigidity
|
22 % |
2 |
lucidity
cranial nerve palsies
moderate to severe headache, meningeal syndrome
|
22 % |
3 |
somnolence, lethargy, or confusion
mild focal neurological deficits
|
50 % |
4 |
stupor
moderate to severe hemiparesis early decerebrate rigidity (posturing)
|
87 % |
5 |
deep coma
decerebrate rigidity (posturing)
moribund appearance
|
100 % |
Fisher Scale
- CT findings can be quantified using the Fisher scale, which reflects the extent of SAH on the initial CT
- the amount of blood in the subarachnoid space and the presence of intracerebral hematoma or hemocephalus are evaluated
- the amount and distribution of blood on CT has a significant predictive value ⇒ higher Fisher grade means a worse prognosis and higher risk of vasospasms
Fisher scale
|
||
Grade | Amount of blood and its localization |
vasospasm risk (%) |
1
|
no hemorrhage detected
|
21 |
2
|
diffuse deposition of blood with a layer < 1 mm thick
|
25 |
3
|
localized clots and/or vertical layers of blood ≥ 1 mm thick
|
37 |
4
|
diffuse or no subarachnoid blood + intracerebral/intraventricular bleeding |
31 |
WFNS SAH scale
WFNS SAH scale (World Federation of Neurological Surgeons Subarachnoid Hemorrhage Scale)
|
|||
---|---|---|---|
grade
|
GCS
|
motor deficit, aphasia
|
mortality (%) |
1
|
15
|
–
|
5 |
2
|
14-13
|
–
|
9 |
3
|
14-13
|
+
|
20 |
4
|
12-7
|
+/-
|
33 |
5
|
6-3
|
+/-
|
77 |