Hunt Hess / Modified Fisher

 

Hunt Hess

Determines whether you will place an EVD or not (EVD if 3 or greater)
HH
Sx
Comments
Mortality (%)
0
Unruptured aneurysm
0-5
1
asymptomatic OR mild HA +/- slight nuchal rigidity
per BAG "no one is a 1"
11
2
HA +/- CN deficits, nuchal rigidty
26
3
Drowsy (ETV or worse), confused, mild focal neuro deficit
usually still following
37
4
stupor, hemiparesis, obtunded
"loc / Wd"
71
5
comatose, posturing
100

Modified Fisher Scale

Tells you risk of vasospasm
MF
SAH
IVH
Vasospasm Risk
1
thin
absent
24%
2
thin
present
33%
3
thick
absent
33%
4
thick
present
40%
Virtually no one has thin, that would be ~ 1 slice of the CT showing blood, hence MF1-2 are usually irrelevant.