The Hunt and Hess Scale, introduced in 1968, remains one of the most widely used clinical grading systems for non-traumatic subarachnoid hemorrhage (SAH).
Subarachnoid Hemorrhage
SAH is a devastating neurological emergency, most commonly caused by the rupture of an intracranial aneurysm. The sudden release of blood into the subarachnoid space increases intracranial pressure and causes severe irritation to the meninges.
The Grading System
The scale relies purely on the patient's clinical presentation upon admission:
- Grade 1: Asymptomatic, or mild headache and slight nuchal rigidity (stiff neck). Survival ~70%.
- Grade 2: Moderate to severe headache, nuchal rigidity, but no neurologic deficit other than cranial nerve palsy. Survival ~60%.
- Grade 3: Drowsiness, confusion, or mild focal deficit. Survival ~50%.
- Grade 4: Stupor, moderate to severe hemiparesis, early decerebrate rigidity, and vegetative disturbances. Survival ~20%.
- Grade 5: Deep coma, decerebrate rigidity, moribund appearance. Survival ~10%.
Grade classification based on clinical signs, ranging from Grade 1 (mild) to Grade 5 (deep coma).
Clinical Utility
The scale is fundamentally prognostic. Lower grades (1-3) typically indicate a better surgical candidate for early aneurysm clipping or coiling, while higher grades (4-5) carry a dismal prognosis where immediate surgical intervention may carry incredibly high mortality risks.