Scale, Hunt and Hess

The Hunt and Hess scale[1] is used to classify the severity of a subarachnoid hemorrhage based on clinical condition. It can be used to predict patient's prognosis/outcome.

Grade Clinical Presentation
1 Asyptomatic, mild headache, slight nuchal rigidity
2 Moderate to severe headache, nuchal rigidity, no neurologic deficit other than cranial nerve palsy
3 Drowsiness, confusion, mild focal neurologic deficit
4 Stupor, moderate-severe hemiparesis
5 Coma, decerebrate posturing

* Extra one point is given for severe systemic disease or severe vasospasm on angiography.

When the Hunt and Hess scale is applied upon the patient's arrival at the hospital, it could be misleading. For example, a comatose patient with significant hydrocephalus could become a GCS 15 after the placement of an external ventricular drain.

  1. Surgical risk as related to time of intervention in the repair of intracranial aneurysms - PubMed ↩︎