Classification of Aneurysm Severity
There are several scales, or grading systems used by Neurosurgeons to classify the severity of a Subarachnoid Hemorrhage (SAH). These are based on a patient’s clinical condition and can be used, to a degree, as a predictor of a patient’s prognosis, or outcome.
One of the oldest systems in use is the Hunt-Hess scale, which was developed in the late 1960’s by Dr. William Edward Hunt and Dr. Robert M Hess. With this scale, used in-frequently now and largely replaced by the World Federation of Neurosurgical Societies classification, the higher grade correlates to a lower survival rate and increased deficits.
- Grade 1
- alert, mild headache, stiff neck
- Grade 2
- alert, vision problems, moderate to severe headache, stiff neck
- Grade 3
- lethargy or confusion, weakness or partial paralysis on one side of body
- Grade 4
- stupor, moderate to severe paralysis on one side of body
- Grade 5
- comatose
- Grade 1
- 75% survival
- Grade 2
- 60% survival
- Grade 3
- 50% survival
- Grade 4
- 30% survival
- Grade 5
- 10% survival
- GCS 15 = good grade
- GCS 14-13 with no motor deficit= fair grade
- GCS 14-13, with hemiparesis or aphasia = tending to poor grade
- GCS 12-8, with or without hemiparesis or aphasia = poor grade
- GCS >8, with or without hemiparesis or aphasia = moribund patient
- Dead: GOS 1
- Vegetative: GOS 2
- Severely disabled: GOS 3
- Moderately disabled: GOS 4
- Good recovery: GOS 5
- no eye opening
- eye open to pain
- eye open to speech
- eye open spontaneously
- no verbal response
- incomprehensible speech
- inappropriate speech
- confused speech
- normal verbal response
- no motor response
- extensor response
- abnormal flexion
- flexor response
- localizing to pain
- normal response. Obeying commands
- No clot seen on CT scan
- Diffuse thin layer of SA clot (<1mm thickness)
- Localized clot or thicker layer of SA clot (>1mm thickness)
- Intracerebral or intraventricular clot with diffuse or no SA clot
Regardless of the grade, any SAH is a serious medical condition that demands immediate medical treatment. As would be expected, survival rates decrease with an increase in severity of a SAH.
Please bear in mind that these statistics are merely a guide and not absolute. The statistics regarding Aneurysms are very often conflicting and confusing.
The World Federation of Neurosurgical Societies classification is based on the Glasgow Coma Score and the finding of aphasia or a motor deficit. It was first published in 1988, and in this scale, the lower the number, the poorer the predicated outcome.
World Federation of Neurosurgical Societies classification
This classification is based on the Glasgow Coma Score
Glasgow Coma Score
The GCS is based on the total score of the following assessments.
The highest possible score is 15 and the lowest possible score is 3. GCS 15-13 is good, GCS 12-9 is critical with a high potential to deteriorate, GCS 8-3 is poor with a high risk of death.
The Fischer scale is a method of grouping the CT scans of SAH into four groups based on the amount of blood evident and thus it is useful in predicting Vasospasm.
Grade Description
Nothing on this website should, in any way be considered medical advice. It is presented as general information only and is not intended to diagnose or treat any type of medical condition. I am not a doctor, nurse, or any other type of medical or health care professional. Nor am I an expert on Aneurysms. However, I am an expert on the experience of having suffered a ruptured Aneurysm and the subsequent treatment I received. This site should not be considered to be, nor is it intended to be, a definitive source of information regarding Aneurysms. I have made every attempt to ensure the accuracy of any information presented here, but again, I am not a medical professional and my own interpretation of this information could be in error.