How it's calculated
A single clinical grade (I-V) is assigned based on level of consciousness, headache severity, nuchal rigidity, and focal neurological deficit at presentation after subarachnoid haemorrhage.
Grade interpretation
| Grade | Description |
|---|---|
| I | Asymptomatic or minimal headache and slight nuchal rigidity |
| II | Moderate-severe headache, nuchal rigidity, no deficit other than cranial nerve palsy |
| III | Drowsiness, confusion, or mild focal deficit |
| IV | Stupor, moderate-severe hemiparesis, possibly early decerebrate rigidity |
| V | Deep coma, decerebrate rigidity, moribund appearance |
Clinical use
- Used to grade clinical severity at presentation after aneurysmal subarachnoid haemorrhage, informing urgency of intervention and prognostic discussion.
- Higher grades are generally associated with worse outcomes, though the original mortality data predate modern neurocritical care, endovascular coiling, and surgical clipping techniques.
- The WFNS (World Federation of Neurosurgical Societies) grading scale, which incorporates GCS directly, is a commonly used alternative with similar clinical purpose.
- Grade should be reassessed after resuscitation and correction of any reversible confounders (e.g. hydrocephalus, seizure) rather than relying solely on the initial presentation grade.
Frequently asked questions
What is the Hunt & Hess Classification used for?
It grades clinical severity at presentation after subarachnoid haemorrhage, helping guide urgency of intervention and prognostic discussion with the patient and family.
Does a higher grade always mean a worse outcome?
Higher grades are generally associated with worse prognosis, but outcomes have improved substantially since the original scale was described, given modern neurocritical care, endovascular treatment, and surgical techniques.
How does this differ from the WFNS scale?
The WFNS (World Federation of Neurosurgical Societies) scale incorporates the Glasgow Coma Scale directly alongside presence of a motor deficit, and is a commonly used alternative with a similar clinical purpose.
Should the grade be reassessed over time?
Yes — grading should reflect the patient's status after resuscitation and correction of reversible confounders such as hydrocephalus or seizure, not only the initial presentation.
References
- Hunt WE, Hess RM. Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg. 1968;28(1):14-20.
- Rosen DS, Macdonald RL. Subarachnoid hemorrhage grading scales: a systematic review. Neurocrit Care. 2005;2(2):110-118.