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Hunt-Hess Grades of Subarachnoid Hemorrhage

Your loved one may be unable to make decisions about treatment. So you may need to decide what’s best for them. Your loved one’s surgeon who is an expert on the brain (neurosurgeon) will talk with you. They may refer to the Hunt-Hess scale (see below). This scale helps the surgeon assess a person's condition. Treatment options can be affected by test results and the grade showing how severe the hemorrhage is.

Healthcare provider with digital tablet talking to woman.

Hunt-Hess grades of subarachnoid hemorrhage

Grade

How your loved one may feel

I

Alert, aware of surroundings, either no symptoms or mild headache or neck stiffness

II

Alert, aware of surroundings, moderate to severe headache, stiff neck, no neurologic defect except cranial nerve palsy

III

Sluggish or confused, has weakness or partial or severe paralysis on one side of the body

IV

Dazed, has total paralysis on one side of the body

V

Comatose, with abnormal posture

Adapted from Hunt WE, Hess RM. Surgical Risk as Related to Time of Intervention in the Repair of Intracranial Aneurysm. J Neurosurg 1968; 28 (1):14–20.

The grade is advanced one level if you have stroke plus a serious systemic disease such as high blood pressure, diabetes, severe hardening of the arteries, or chronic lung disease. It's also raised one level if you have stroke and vasospasm.

Your neurosurgeon may use another aneurysm and neurological grading system, such as the Glascow Coma Scale or the World Federation of Neurological Surgeons grading scale.

Online Medical Reviewer: Joseph Campellone MD
Online Medical Reviewer: Marianne Fraser MSN RN
Online Medical Reviewer: Raymond Kent Turley BSN MSN RN
Date Last Reviewed: 8/1/2021
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