Subarachnoid Hemorrhage Assessment Scales

Clinical Assessment with Hunt and Hess Scale

The Hunt and Hess scale is a clinical grading system that assesses neurological severity in subarachnoid hemorrhage patients based on symptoms and level of consciousness, while the modified Fischer scale evaluates the amount and distribution of blood to predict vasospasm risk, as recommended by the International Journal of Stroke 1, 2
The severity determined by Hunt and Hess grading is the most useful indicator of outcome after aneurysmal SAH and should be determined rapidly to guide treatment decisions and prognostication, according to Stroke 4, 5
High-grade patients (Hunt and Hess 4-5) can achieve favorable outcomes with aggressive early treatment, with 39-40% achieving favorable outcomes, as reported in Stroke 4
The scale guides urgent treatment decisions, as patients with higher grades require more intensive monitoring and earlier aneurysm securing, as stated in the International Journal of Stroke 1, 2

The Fisher Grading Scale is a CT-based system with prognostic significance for development of vasospasm and delayed ischemic neurological deficits, as described in the Journal of Neurointerventional Surgery 6, 7
The Fisher scale predicts vasospasm risk, with Fisher grade 3 having the highest association with symptomatic vasospasm, according to the Journal of Neurointerventional Surgery 6, 7

Guidelines recommend using validated scales including Hunt and Hess, World Federation of Neurological Surgeons (WFNS), Glasgow Coma Scale (GCS), and Fisher Scale to determine SAH severity, as recommended by the International Journal of Stroke 1, 2
The combined clinical (Hunt and Hess) and radiographic (Fisher) grading provides comprehensive outcome prediction, as reported in Stroke 4
The scales should be applied at admission and serially reassessed, as clinical deterioration may occur from rebleeding, hydrocephalus, or vasospasm, as stated in the International Journal of Stroke 1 and Stroke 5