Clinical Grading
Once SAH is diagnosed, the severity of the initial bleed should be determined as it is the most useful indicator of outcome of aneurysmal SAH [11]. Clinical grading systems include the Hunt and Hess classification (Table 3) [78] and that of The World Federation of Neurosurgical Societies (Table 4) [79].
Table 3: Hunt and Hess SAH classification system
| Clinical picture | Grade |
| Asymptomatic, mild headache, slight nuchal rigidity | 1 |
| Moderate to severe headache, nuchal rigidity, no neurological deficit other than cranial nerve palsy | 2 |
| Drowsiness / confusion, mild focal neurological deficit | 3 |
| Stupor, moderate-severe hemiparesis | 4 |
| Coma, decerebrate posturing | 5 |
Table 4: World Federation of Neurosurgeons SAH grading system
| Glasgow Coma Score | Motor deficit* | Grade |
| 15 | Absent | 1 |
| 13-14 | Absent | 2 |
| 13-14 | Absent | 3 |
| 7-12 | Present or absent | 4 |
| 3-6 | Present or absent | 5 |
* Where a motor deficit refers to a major focal deficit
Learning Bite
The outcome of SAH is correlated directly with the degree of neurological dysfunction at time of first presentation [78,79].