Clinical Grading

Once SAH is diagnosed, the severity of the initial bleed should be determined as it is the most useful indicator of outcome of aneurismal SAH [11]. Clinical grading systems include the Hunt and Hess classification (Table 3) [78] and that of The World Federation of Neurosurgical Societie (Table 4) [79].

Table 3: Hunt and Hess SAH classification system

Clinical picture Grade
Asymptomatic, mild headache, slight nuchal rigidity 1
Moderate to severe headache, nuchal rigidity, no neurological deficit other than cranial nerve palsy 2
Drowsiness / confusion, mild focal neurological deficit 3
Stupor, moderate-severe hemiparesis 4
Coma, decerebrate posturing 5

Table 4: World Federation of Neurosurgeons SAH grading system

Glasgow Coma Score Motor deficit* Grade
15 Absent 1
13-14 Absent 2
13-14 Absent 3
7-12 Present or absent 4
3-6 Present or absent 5

* Where a motor deficit refers to a major focal deficit

Learning Bite

The outcome of SAH is correlated directly with the degree of neurological dysfunction at time of first presentation [78,79].