Clinical grade
I — asymptomatic, or mild headache and slight neck stiffness
II — moderate-to-severe headache, neck stiffness, no deficit except cranial-nerve palsy
III — drowsiness, confusion, or mild focal deficit
IV — stupor, moderate-to-severe hemiparesis
V — deep coma, decerebrate posturing, moribund
Evidence
Original publication
Hunt WE, Hess RM. Surgical risk as related to time of intervention in the repair of intracranial aneurysms. Introduced the I–V clinical grading of subarachnoid haemorrhage (headache and meningism through to deep coma and moribund appearance) to time aneurysm surgery; higher grades carried markedly higher operative mortality.
Journal of Neurosurgery, 1968
Guideline
Still in routine use for aneurysmal SAH alongside the WFNS grade; the 2023 AHA/ASA SAH guideline notes that admission clinical grade is among the strongest predictors of outcome.
Last reviewed: 2026-09
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