Hunt and Hess grading system

Last revised by Dr Dominic Kite on 13 May 2021

The Hunt and Hess scale describes the clinical severity of subarachnoid hemorrhage resulting from the rupture of an intracerebral aneurysm and is used as a predictor of survival.

  • grade 1
    • asymptomatic or minimal headache and slight neck stiffness
    • 70% survival
  • grade 2
    • moderate to severe headache; neck stiffness; no neurologic deficit except cranial nerve palsy
    • 60% survival
  • grade 3
    • drowsy; minimal neurologic deficit
    • 50% survival
  • grade 4
    • stuporous; moderate to severe hemiparesis; possibly early decerebrate rigidity and vegetative disturbances
    • 20% survival
  • grade 5
    • deep coma; decerebrate rigidity; moribund
    • 10% survival

History and etymology

It was first described in 1968 by two neurosurgeons from Ohio, USA:

  • William Edward Hunt (1921-1999), neurologist and neurosurgeon; also of Tolosa-Hunt syndrome
  • Robert M Hess (1931-2019) neurosurgeon

See also

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