Hunt and Hess Scale

Updated: Apr 18, 2019
  • Author: Stavropoula I Tjoumakaris, MD; more...
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Hunt and Hess Scale

The Hunt and Hess scale was developed in 1968 as a clinical grading system to predict prognosis and outcome in patients with subarachnoid hemorrhage (SAH). [1, 2] A higher grade predicts a poor outcome and lower likelihood of survival. [3, 4]

The Hunt and Hess scale is widely used for categorizing severity of SAH; however, it has been criticized for its interobserver variability and minimal clinical difference between grade 1 and 2. [5, 6]

  • Grade 1: Asymptomatic or mild headache

  • Grade 2: Cranial nerve palsy or moderate to severe headache/nuchal rigidity

  • Grade 3: Mild focal deficit, lethargy, or confusion

  • Grade 4: Stupor and/or hemiparesis

  • Grade 5: Deep coma, decerebrate posturing, moribund appearance