The Hunt and Hess scale is a widely used grading system that classifies the severity of subarachnoid hemorrhage based on clinical presentation. It ranges from Grade I (asymptomatic or minimal symptoms) to Grade V (deep coma). Higher Hunt and Hess grades are generally associated with increased mortality.
0 Unruptured aneurysm
Hunt and Hess Stroke Scale 1- Asymptomatic or minimal headache and slight nuchal rigidity
1a no acute meningeal/brain reaction, but with fixed neuro deficit
2 Moderate-severe headaches, nuchal rigidity, cranial nerve palsy
3 Drowsiness, confusion, or mild focal deficit
Hunt and Hess Stroke Scale 4 Stupor, severe hemiparesis, vegetative disturbance
Hunt and Hess Stroke Scale 5 Deep coma, decerebrate rigidity, moribund appearance
Hypertension, diabetes, arteriosclerosis, chronic pulmonary disease, or vasospasm assigns patient to next less favorable category
1 Asymptomatic, mild headache, slight nuchal rigidity.
2 Moderate to severe headache, nuchal rigidity, no neurologic deficit other than cranial nerve palsy.
3 Drowsiness / confusion, mild focal neurologic deficit.
4 Stupor, moderate-severe hemiparesis.
Hunt and Hess Stroke Scale 5 Coma, decerebrate posturing 1).