Subarachnoid haemorrhage (SAH): grading and outcome scales

Written and reviewed by Dr Ibrahim Imam, Consultant Neurologist. Last reviewed .

Subarachnoid haemorrhage (SAH): grading and outcome scales. I: Asymptomatic or mild symptoms. Fully referenced neurology checklist.

Hunt and Hess scale

  • I: Asymptomatic or mild symptoms
  • II: Moderate to severe symptoms and signs
  • III: Drowsiness, confusion, and mild motor deficits
  • IV: Stupor and moderate to severe clinical signs
  • V: Coma and decerebrate posturing

World Federation of Neurological Surgeons scale

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Fisher CT grading scale

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Fisher revised (Claassen) CT grading scale

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Outcome scales

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References

  1. Hunt WE, Hess RM. Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg 1968; 28:14-20.
  2. Report of World Federation of Neurological Surgeons Committee on a Universal Subarachnoid Hemorrhage Grading Scale. J Neurosurg 1988; 68:985-986.
  3. Fisher C, Kistler J, Davis J. Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery 1980; 6: 1–9.
  4. Claassen J, Bernardini GL, Kreiter K, et al. Effect of cisternal and ventricular blood on risk of delayed cerebral ischemia after subarachnoid hemorrhage, the fisher scale revisited. Stroke 2001; 32:2012-2020.
  5. Witsch J, Frey HP, Patel S, et al. Prognostication of long-term outcomes after subarachnoid hemorrhage: The FRESH score. Ann Neurol 2016; 80:46-58. 
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