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Hunt & Hess Scale

Hunt & Hess Audit

Clinical Staging of SAH Severity

Clinical Presentation Audit

Prognostic Axiom

The Hunt & Hess scale remains the primary tool for initial clinical triage and communication between trauma and neurosurgical teams.

Symptomatic Severity Probe

Input the symptomatic presentation to determine the Hunt & Hess Grade and associated uncorrected mortality risk.

Guidelines & Evidence

Verified

Last Review: 2026-07-17

When to Use

When to Use

Classifying the severity of subarachnoid haemorrhage (SAH) based on clinical presentation.
Predicting perioperative mortality and surgical risk.
Deciding on the timing of neurosurgical or endovascular intervention (Grade 1–3 vs. 4–5).

How it Works

The 5 Grades

Grade 1: Asymptomatic or mild headache, slight nuchal rigidity.
Grade 2: Moderate to severe headache, nuchal rigidity, cranial nerve palsy.
Grade 3: Drowsiness, confusion, or mild focal deficit.
Grade 4: Stupor, moderate to severe hemiparesis, early decerebrate rigidity.
Grade 5: Deep coma, decerebrate rigidity, moribund.

Systemic Modifiers

Serious systemic disease (HTN, Diabetes, severe COPD) or severe vasospasm on angiography results in upgrading the patient to the next more severe grade.

Clinical Pearls

Surgical Timing

Historically, patients with Grade 4 and 5 were managed conservatively until their grade improved. However, early intervention for ruptured aneurysms is now standard for almost all grades to prevent re-bleeding, with aggressive ICP management used to "bridge" Grade 4/5 patients.

The Evidence

Primary Reference

Surgical risk as related to time of intervention in the repair of intracranial aneurysms

Hunt WE et al. • J Neurosurg. 1968;28(1):14-20

View Source

Last Comprehensive Review: 2026-07-17

In Recent Clinical News

Scanning Medical Journals

No new significant updates or guidelines matching this topic were found today. We will check again soon.