What is the Hunt-Hess grading system for SAH?

Grade 1: asymptomatic, mild headache; Grade 2: moderate-severe headache, nuchal rigidity, no neurological deficit except CN palsy; Grade 3: drowsy, mild neurological deficit; Grade 4: stupor, moderate-severe hemiparesis; Grade 5: deep coma, moribund appearance; grades correlate with surgical risk and outcome.

What does the modified Fisher scale predict?

Modified Fisher: Grade 1 (no SAH or IVH) = vasospasm risk 0%; Grade 2 (thin diffuse SAH, no clot): 2%; Grade 3 (thick cisternal SAH): 7%; Grade 4 (diffuse SAH + IVH or thick SAH with IVH): 11%; correlates with delayed cerebral ischemia (DCI) risk.

What is the nimodipine regimen for cerebral vasospasm prevention?

Nimodipine 60 mg orally every 4 hours for 21 days; reduces DCI and improves neurological outcome by 34%; mechanism: cerebral calcium channel block; IV nimodipine (0.5-1 mg/h) for patients unable to take orally; hypotension requires dose reduction.

What is the window for aneurysm clipping vs coiling?

Definitive aneurysm treatment (clipping or endovascular coiling) within 24-72 hours of SAH presentation to prevent rebleeding (rebleeding rate 20% in first 24h without treatment); ISAT trial: coiling preferred over clipping for suitable aneurysm anatomy.

What triple-H therapy was previously used for vasospasm?

Historically: Hypertension (MAP 80-100) + Hypervolemia + Hemodilution; now replaced by induced hypertension only (MAP 80-100 mmHg) plus nimodipine; hypervolemia not beneficial and may cause pulmonary edema; induced hypertension for symptomatic DCI during monitoring.

Subarachnoid Haemorrhage Hunt-Hess Grade and Fisher Scale

Calculates Hunt-Hess clinical grade and modified Fisher CT grade for subarachnoid haemorrhage to predict surgical risk, vasospasm risk, and outcomes, with nimodipine dosing for cerebral vasospasm prevention.

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Frequently Asked Questions

What is the Hunt-Hess grading system for SAH?

What does the modified Fisher scale predict?

What is the nimodipine regimen for cerebral vasospasm prevention?

What is the window for aneurysm clipping vs coiling?

What triple-H therapy was previously used for vasospasm?