Modified Fisher Grading Scale for Subarachnoid Hemorrhage [Neurosurgery Wiki]

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====== Modified Fisher Grading Scale for Subarachnoid Hemorrhage ======

{{rss>https://pubmed.ncbi.nlm.nih.gov/rss/search/1naYwjERihpwD2_AZROc91Ta3P9ZtqHeqOkVZFoX9-4JBN19bQ/?limit=15&utm_campaign=pubmed-2&fc=20240104072012}}
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see also OLD [[Fisher Scale]]
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https://www.mdcalc.com/calc/3837/modified-fisher-grading-scale-subarachnoid-hemorrhage-sah

{{::modifiedfisherscale.jpg|}}

====== Modified Fisher Grading Scale 4 ======

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Extensive [[subarachnoid hemorrhage]] distributed throughout [[perimesencephalic cistern]]s (predominantly in the [[chiasmatic cistern]]), [[prepontine cistern]], both [[Sylvian fissure]]s, and [[interhemispheric fissure]], with a component of bifrontal parasagittal [[intraparenchymal hematoma]] with mild adjacent [[vasogenic edema]]. The hemorrhage also extends into the [[ventricular system]] ([[third ventricle]] and [[lateral ventricle]]s). Findings consistent with modified Fisher grade IV subarachnoid hemorrhage.

This extension is compatible with an [[aneurysmal subarachnoid hemorrhage]] pattern.

Erasure of cerebral [[sulci]], predominantly frontotemporal, in relation to diffuse [[cerebral edema]].

Increased ventricular size for the patient's age.
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**For prediction of Symptomatic vasospasm**

Scoring system

Abbreviations
SAH: subarachnoidal hemorrhage
IVH: intraventricular hemorrhage

**Diffuse thick SAH**

IVH: 4 points

No IVH: 3 points

**Localized thick SAH**

IVH: 4 points

No IVH: 3 points

**Diffuse thin SAH**

IVH: 2 points

No IVH: 1 points

**Localized thin SAH**

IVH: 2 points

No IVH: 1 points

**No SAH**

IVH: 2 points

No IVH: 0 points


Prediction of symptomatic vasospasm

1 point: 24%

2 points: 33%

3 points: 33%

4 points: 40%

((Frontera JA, Claassen J, Schmidt JM, Wartenberg KE, Temes R, Connolly ES, et al. Prediction of symptomatic vasospasm after subarachnoid hemorrhage: the modified fisher scale. Neurosurgery. 2006 Jul;59(1):21-7.)).

Additional intracerebral hemorrhage (ICH) was associated with an increased risk of [[delayed cerebral ischemia]] (DCI). Furthermore, adding the presence or absence of ICH to the [[modified Fisher Scale]] (mFS) improved the identification of patients at the highest risk for the development of DCI. Thus, a simple adjustment of the mFS might help to identify patients at high risk for DCI
((Platz J, Güresir E, Wagner M, Seifert V, Konczalla J. Increased risk of
delayed cerebral ischemia in subarachnoid hemorrhage patients with additional
intracerebral hematoma. J Neurosurg. 2016 Mar 11:1-7. [Epub ahead of print]
PubMed PMID: 26967776.
)).
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The mFS and the modified Graeb score (mGS) have similar prognostic utility. Accounting for IVH volume improved prediction of Delayed cerebral ischemia (DCI) by the mFS
((Eagles ME, Jaja BNR, Macdonald RL. Incorporating a Modified Graeb Score to the
Modified Fisher Scale for Improved Risk Prediction of Delayed Cerebral Ischemia
Following Aneurysmal Subarachnoid Hemorrhage. Neurosurgery. 2017 Apr 17. doi:
10.1093/neuros/nyx165. [Epub ahead of print] PubMed PMID: 28419304.
)).

===== Hijdra sum score =====
see also [[Hijdra sum score]]

===== Claassen CT scale =====
see [[Claassen CT scale]].