Subarachnoid hemorrhage classification

	Subarachnoid Hemorrhage Microchapters
Home
Patient Information
Overview
Classification
Pathophysiology
Causes
Differentiating Subarachnoid Hemorrhage from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
CT
MRI
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
AHA/ASA Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage (2012) Risk Factors/Prevention Natural History/Outcome Clinical Manifestations/Diagnosis Medical Measures to Prevent Rebleeding Surgical and Endovascular Methods Hospital Characteristics/Systems of Care Anesthetic Management Cerebral Vasospasm and DCI Hydrocephalus Seizures Associated With aSAH Medical Complications
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Subarachnoid hemorrhage classification On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Subarachnoid hemorrhage classification All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Subarachnoid hemorrhage classification
CDC on Subarachnoid hemorrhage classification
Subarachnoid hemorrhage classification in the news
Blogs on Subarachnoid hemorrhage classification
Directions to Hospitals Treating Subarachnoid hemorrhage
Risk calculators and risk factors for Subarachnoid hemorrhage classification

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Sara Mehrsefat, M.D. [3]

Classification

According to the etiology, spontaneous subarachnoid hemorrhage may be classified into aneurysmal and nonaeurysmal subarachnoid hemorrhage.

Subarachnoid hemorrhage

Traumatic

Aneurysmal subarachnoid hemorrhage

Nonaneurysmal subarachnoid hemorrhage

Ruptured saccular aneurysms

Occult aneurysmal

Perimesencephalic nonaneurysmal subarachnoid hemorrhage

Vascular malformations

Intracranial arterial dissection

Other causes

There are several grading scales available for subarachnoid hemorrhage. These have been derived by retrospectively matching characteristics of patients with their outcomes. In addition to the ubiquitously used Glasgow Coma Scale, three other specialized scores are in use.^[1]

Hunt and Hess Scale

The first scale of severity, described by Hunt and Hess in 1968:^[2]

Grade 1: Asymptomatic; or minimal headache and slight nuchal rigidity. Approximate survival rate 70%.
Grade 2: Moderate to severe headache; nuchal rigidity; no neurologic deficit except cranial nerve palsy. 60%.
Grade 3: Drowsy; minimal neurologic deficit. 50%.
Grade 4: Stuporous; moderate to severe hemiparesis; possibly early decerebrate rigidity and vegetative disturbances. 20%.
Grade 5: Deep coma; decerebrate rigidity; moribund. 10%.

Fisher Grade

The Fisher Grade classifies the appearance of subarachnoid hemorrhage on CT scan:^[3]

Grade 1= No hemorrhage evident
Grade 2= Subarachnoid hemorrhage less than 1 mm thick
Grade 3= Subarachnoid hemorrhage more than 1 mm thick
Grade 4= Subarachnoid hemorrhage of any thickness with intra-ventricular hemorrhage (IVH) or parenchymal extension

World Federation of Neurosurgeons

The World Federation of Neurosurgeons classification:^[4]

Class 1 - GCS (Glasgow Coma Scale)15
Class 2 - GCS 13-14 without focal neurological deficit
Class 3 - GCS 13-14 with focal neurological deficit
Class 4 - GCS 7-12 with or without focal neurological deficit
Class 5 - GCS <7 with or without focal neurological deficit

References

↑ Rosen D, Macdonald R (2005). "Subarachnoid hemorrhage grading scales: a systematic review". Neurocrit Care. 2 (2): 110–8. PMID 16159052.
↑ Hunt W, Hess R (1968). "Surgical risk as related to time of intervention in the repair of intracranial aneurysms". J Neurosurg. 28 (1): 14–20. PMID 5635959.
↑ Fisher C, Kistler J, Davis J (1980). "Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning". Neurosurgery. 6 (1): 1–9. PMID 7354892.
↑ Teasdale G, Drake C, Hunt W, Kassell N, Sano K, Pertuiset B, De Villiers J (1988). "A universal subarachnoid hemorrhage scale: report of a committee of the World Federation of Neurosurgical Societies". J Neurol Neurosurg Psychiatry. 51 (11): 1457. PMID 3236024.

Template:WH Template:WS

[1] Rosen D, Macdonald R (2005). "Subarachnoid hemorrhage grading scales: a systematic review". Neurocrit Care. 2 (2): 110–8. PMID 16159052.

[2] Hunt W, Hess R (1968). "Surgical risk as related to time of intervention in the repair of intracranial aneurysms". J Neurosurg. 28 (1): 14–20. PMID 5635959.

[3] Fisher C, Kistler J, Davis J (1980). "Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning". Neurosurgery. 6 (1): 1–9. PMID 7354892.

[4] Teasdale G, Drake C, Hunt W, Kassell N, Sano K, Pertuiset B, De Villiers J (1988). "A universal subarachnoid hemorrhage scale: report of a committee of the World Federation of Neurosurgical Societies". J Neurol Neurosurg Psychiatry. 51 (11): 1457. PMID 3236024.

[1]

[2]

[3]

[4]