What is the Hunt and Hess grading system for the clinical assessment of subarachnoid hemorrhage (SAH)?

Updated: Dec 07, 2018
  • Author: Tibor Becske, MD; Chief Editor: Helmi L Lutsep, MD  more...
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The Hunt and Hess grading system is as follows:

  • Grade 0 - Unruptured aneurysm

  • Grade I - Asymptomatic or mild headache and slight nuchal rigidity

  • Grade Ia - Fixed neurologic deficit without acute meningeal/brain reaction

  • Grade II - Cranial nerve palsy, moderate to severe headache, nuchal rigidity

  • Grade III - Mild focal deficit, lethargy, or confusion

  • Grade IV - Stupor, moderate to severe hemiparesis, early decerebrate rigidity

  • Grade V - Deep coma, decerebrate rigidity, moribund appearance

In the Hunt and Hess system, the lower the grade, the better the prognosis. Grades I-III generally are associated with favorable outcome; these patients are candidates for early surgery. Grades IV and V carry a poor prognosis; these patients need stabilization and improvement to grade III before surgery is undertaken. Some recommend more aggressive management for patients with poor clinical grade.

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