The Hunt and Hess Scale: Review

Mahesh Saibanna Bamani

Associate Professor, Dr. Deepak Patil Nursing Institute, Borpadale, Kolhapur, Maharashtra, India.

*Corresponding Author E-mail: Mahesh.bamani@gmail.com

ABSTRACT:

Sudden bleeding into the subarachnoid space is known as subarachnoid hemorrhage. The majorities of aneurysms are asymptomatic, and do not burst, but when they gradually grow unpredictably increase the risk of rupture and starts bleeding internally into subarachnoid space which is dangerous. Aneurysms can happen to anyone at any age. Proper diagnosis at right time can prevent rupture and serious complication due to SAH which may alter level of consciousness and other physiological functions in body. The assessment, Monitoring, Treatment and their outcome prediction is complex and challenging for nurses. The Hunt and Hess scale is useful for identifying severity of SAH and predictor of patient outcome.

KEYWORDS: SAH, Hunt and Hess Scale, Aneurysms.

INTRODUCTION:

Among neurological emergencies, SAH is a severely distressing cerebrovascular disease with complex causes that endangers brain perfusion and function and has a higher morbidity and fatality rate.¹

SAH is defined as "non-traumatic bleeding into the subarachnoid area, the region between the arachnoid and the piamater of the central nervous system, showing prompt growing symptoms of neurological sequelae.²

With a median case-fatality of 27–44%, headaches brought on by subarachnoid hemorrhages (SAH) from burst aneurysms are among the deadliest.³

It is one of the most serious cerebrovascular diseases that threatens brain perfusion and function and has higher rates of morbidity and mortality. It is one of the neurological crises. It still has a mortality rate that ranges from 8.3% to 66.7%.

Subarachnoid hemorrhage (SAH), which affects 16,000 to 17,000 persons annually in the US, which is by a ruptured intracranial aneurysm (IA).

According to population-based research, it is associated with substantial morbidity and mortality; estimates reveal that 40% to 44% of individuals affected die within 30 days of their initiation.⁴

According to past studies smoking is the main cause of SAH, Additional risk factors for SAH include estrogen deficiency, alcohol use, and hypertension. SAH patients are more likely to have family history of having the illness, which indicates a heritable component.⁵

The Hunt and Hess scale which was developed in 1968 is one of the grading systems used to classify the severity of a subarachnoid hemorrhage based on the patient's clinical condition. It is used to forecast the patient's prognosis or result, with a higher grade indicating a worse survival rate. The scale bears the names of two doctors: Dr. Robert McDonald Hess and Dr. William E. Hunt.⁶

Table No.1: The Hunt and Hess Scale

Description	Grade
Asymptomatic, mild headache, slight nuchal rigidity	1
Moderate to severe headache, nuchal rigidity, no neurologic 2 deficit other than cranial nerve palsy	2
Drowsiness / confusion, mild focal neurologic deficit	3
Stupor, moderate-severe hemiparesis	4
Coma, decerebrate posturing	5

CONCLUSION:

Subarachnoid hemorrhage (SAH) is a life threatening condition. Early detection and prompt treatment of aneurysms can prevent further complications. The management of patient with subarachnoid hemorrhage (SAH) is challenging one as internal bleeding into subarachnoid space can lead for serious complications and sudden death. The hunt and Hess scale is useful in clinical practice to detect the severity of a subarachnoid hemorrhage based on the patient's clinical condition and management of patients accordingly.

REFERENCE:

1. Nagashima, H., Miwa, T., Horiguchi, T., Tomio, R., Nakagawa, Y. and Yoshida, K. (2018) Hyperperfusion after Clipping of Aneurysm: A Rare Entity. Journal of Stroke and Cerebrovascular Diseases, 27, 1425-1430. https://doi.org/10.1016/j.jstrokecerebrovasdis.2017.11.024

2. Sacco, R.L., Kasner, S.E., Broderick, J.P., Caplan, L.R., Connors, J.J.B., Culebras, A., et al. (2013) An Updated Definition of Stroke for the 21st Century: A Statement for Healthcare Professionals from the American Heart Association/American Stroke Association. Stroke, 44, 2064-2089. https://doi.org/10.1161/STR.0b013e318296aeca

3. Nieuwkamp DJ, Setz LE, Algra A, et al. Changes in case fatality of aneurysmal subarachnoid haemorrhage over time, according to age, sex, and region: a meta-analysis. Lancet Neurol. 2009;8(7):635–42.

4. Roderick J, Brott T, Tomsick T, Huster G, Miller R. The risk of subarachnoid and intracerebral hemorrhages in blacks as compared with whites. N Engl J Med. 1992; 326: 733–736.

5. Knekt P, Reunanen A, Aho K, Heliovaara M, Rissanen A, Aromaa A, Impivaara O. Risk factors for subarachnoid hemorrhage in a longitudinal population study. J Clin Epidemiol. 1991; 44: 933–939.

6. Hunt WE, Hess RM. “Surgical risk as related to time of intervention in the repair of intracranial aneurysms.” Journal of Neurosurgery 1968 Jan; 28(1):14-20.

Received on 13.02.2023 Modified on 01.03.2023

Int. J. of Advances in Nur. Management. 2023; 11(2):125-126.

DOI: 10.52711/2454-2652.2023.00030