Hunt and Hess Scale for Subarachnoid Haemorrhage
Classifies clinical severity of subarachnoid haemorrhage (SAH) from ruptured aneurysm. Predicts surgical risk and outcome. Higher grade correlates with worse prognosis.
Score interpretation
→ Hunt-Hess Grade I–II: Good grade SAH. Surgical/endovascular aneurysm treatment within 24–48 hours (clipping or coiling). Nimodipine 60 mg every 4 hours for 21 days. Strict BP control; ICU monitoring; repeat CT at 24 hours; daily TCD for vasospasm.
→ Hunt-Hess Grade III: Intermediate risk. Aim for aneurysm treatment within 24 hours if haemodynamically stable. Nimodipine; ICU; ventriculostomy if hydrocephalus; vasospasm monitoring; BP managed to avoid hypo/hypertension.
→ Hunt-Hess Grade IV–V: Poor grade SAH. High mortality (40–80%). Aggressive ICU management; intracranial pressure monitoring; nimodipine; aneurysm treatment where feasible; early goals-of-care discussion with family; consider withdrawal of care in Grade V with poor prognosis indicators.
Interpretation bands for the Hunt-Hess SAH. Apply clinical judgement and local guidance.
References
Related
Curated clinical cross-links plus same-class fallbacks.
- Aciclovir 800mg Tablets (Ramsay Hunt Syndrome / Herpes Zoster Oticus) · Antiviral — nucleoside analogue (herpes zoster treatment)
- Valaciclovir (ENT — Ramsay Hunt / Bell's Palsy) · Antiviral (Prodrug of Aciclovir)
- Nimodipine · Calcium Channel Blocker (neuroprotective)
- Dexamethasone (Paediatric) · Corticosteroid — Croup / Bacterial Meningitis / Post-Extubation Stridor / Cerebral Oedema
- Tranexamic Acid (Surgical / Trauma Haemorrhage) · Antifibrinolytic (Haemostatic)
- Acute Stroke / TIA Assessment · NICE NG128; RCP Stroke Guidelines 2023
- Status Epilepticus (Adults) · NICE CG137; ESEM guidelines; RCP Neurology Guidelines
- Suspected Subarachnoid Haemorrhage · NICE NG228; RCEM 2023; AHA/ASA 2023
- Adult Head Injury · NICE NG232 (2023)
- Bell's Palsy / Facial Nerve Palsy · ENT UK 2017; AAN
- Vertigo Workup · ENT UK; NICE CKS
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.