Hunt and Hess Scale
Interactive Hunt and Hess scale for aneurysmal subarachnoid hemorrhage with all five clinical grades, bedside distinctions, and safety-focused interpretation.
Reviewed by Zaka Ahmed, MD Clinical reference · 5 min read
Hunt and Hess grade
Select the single description that best matches the patient’s clinical state at the documented timepoint.
Educational use only. The grade does not determine an individual outcome or treatment ceiling. Document examination timing and reversible confounders.
Clinical notes & interpretation Scoring guidance, pitfalls, FAQs, and references
The Hunt and Hess scale describes the clinical condition of a patient with aneurysmal subarachnoid hemorrhage from grade I to V.
- → The grade is descriptive: headache and nuchal rigidity at the low end, confusion or focal deficit in the middle, and stupor or coma at the high end.
- → Sedation, hydrocephalus, seizure, metabolic disturbance, and resuscitation can change the examination; record timing and confounders.
The Hunt and Hess scale remains a widely recognized clinical shorthand in aneurysmal subarachnoid hemorrhage (aSAH). Its strength is speed; its limitation is subjectivity. Use the grade to communicate the examination, not to generate an automated mortality prediction or a ceiling of care.
What the grade adds
A concise grade helps handoffs and cohort description, but it does not replace a complete neurologic examination, the World Federation of Neurosurgical Societies grade, or imaging measures such as modified Fisher grade. A patient can also move between grades as hydrocephalus is treated, sedation is lightened, or rebleeding occurs.
Avoid false precision
Older publications attached surgical mortality percentages to each grade. Those historical estimates should not be presented as contemporary individual predictions: case mix, aneurysm treatment, neurocritical care, and withdrawal-of-care practices have changed substantially.
References.
- Hunt WE, Hess RM. Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg. 1968;28:14–20. PubMed
- Hoh BL, Ko NU, Amin-Hanjani S, et al. 2023 Guideline for the Management of Patients With Aneurysmal Subarachnoid Hemorrhage. Stroke. 2023;54:e314–e370. AHA/ASA guideline