Stroke

Subarachnoid Hemorrhage Grading Scales

Glasgow Coma Scale

The GCS is not a true SAH grading scale, but is rather a standardized method for evaluating the level of consciousness in a number of neurologic conditions including SAH. The GCS assigns points based on three parameters of neurologic function:

• Eye opening (spontaneous = 4, response to verbal command = 3, response to pain = 2, no eye opening = 1)
• Best verbal response (oriented = 5, confused = 4, inappropriate words = 3, incomprehensible sounds = 2, no verbal response = 1)
• Best motor response (obeys commands = 6, localizing response to pain = 5, withdrawal response to pain = 4, flexion to pain = 3, extension to pain = 2, no motor response = 1)

• Grade 0 for unruptured aneurysms
• Grade 1: Asymptomatic or mild headache and slight nuchal rigidity
• Grade 1a for a fixed neurologic deficit without other signs of SAH
• Grade 2: Moderate to severe headache, stiff neck, no neurologic deficit except cranial nerve palsy
• Grade 3: Drowsy or confused, mild focal neurologic deficit
• Grade 4: Stupor, moderate or severe hemiparesis
• Grade 5: Deep coma, decerebrate posturing

• Grade 1: GCS score 15, no motor deficit
• Grade 2: GCS score 13 to 14, no motor deficit
• Grade 3: GCS score 13 to 14, with motor deficit
• Grade 4: GCS score 7 to 12, with or without motor deficit
• Grade 5: GCS score 3 to 6, with or without motor deficit