Neuro-ICU Book

Question 1

Hunt and Hess Grade 1 for SAH

Answer 1

Asymptomatic or mild HA and slight nuchal rigidity.

Question 2

Hunt and Hess Grade 2 for SAH

Answer 2

Moderate to severe HA, nuchal rigidity, no neurologic deficit other than CN palsy.

Question 3

Hunt and Hess Grade 3 for SAH

Answer 3

Drowsiness, confusion, or mild focal deficit.

Question 4

Hunt and Hess Grade 4 for SAH

Answer 4

Stupor, moderate to severe hemiparesis, possibly early decerebrate rigidity and vegetative disturbances.

Question 5

Hunt and Hess Grade 5 for SAH

Answer 5

Deep coma, decerebrate rigidity, moribund appearance.

Question 6

Grade 1 World Federation of Neurosurgical Societies Scale for SAH

Answer 6

GCS 15 without focal deficit.

Question 7

Grade 2 World Federation of Neurosurgical Societies Scale for SAH

Answer 7

GCS 13-14 without focal deficit.

Question 8

Grade 3 World Federation of Neurosurgical Societies Scale for SAH

Answer 8

GCS 13-14 with focal deficit.

Question 9

Grade 4 World Federation of Neurosurgical Societies Scale for SAH

Answer 9

GCS 7-12 with or without focal deficit.

Question 10

Grade 5 World Federation of Neurosurgical Societies Scale for SAH

Answer 10

GCS 3-6 with or without focal deficit.

Question 11

Fisher grade 1 for SAH

Answer 11

No detectable SAH.

Question 12

Fisher grade 2 for SAH

Answer 12

Diffuse SAH, no localized clot > 3 mm thick or vertical layers > 1 mm thick.

Question 13

Fisher grade 3 for SAH

Answer 13

Localized clot > 5 x 3 cm in subarachnoid space, or > 1 mm in vertical thickness.

Question 14

Fisher grade 4 for SAH

Answer 14

Intraparenchymal or IVH with either absent or minimal SAH.

Question 15

Clinical implications of the Fisher scale

Answer 15

Greater Fisher grade correlates to increased risk of developing vasospasm.

Question 16

Modified Fisher grade 0 for SAH

Answer 16

No SAH or IVH.

Question 17

Modified Fisher grade 1 for SAH

Answer 17

Minimal/thin SAH with no IVH.

Question 18

Modified Fisher grade 2 for SAH

Answer 18

Minimal/thin SAH with IVH.

Question 19

Modified Fisher grade 3 for SAH

Answer 19

Thick SAH with no IVH.

Question 20

Modified Fisher grade 4 for SAH

Answer 20

Thick SAH with IVH.

Question 21

Volume status in SIADH

Answer 21

Euvolemic or hypervolemic state.

Question 22

Urine osmolarity and urine Na in SIADH patients.

Answer 22

Urine osmolarity > 100mOsm/kg

Urine Na > 40 mmol/L

Question 23

FENa for CWS and SIADH

Answer 23

FENa < 1% for volume depletion due to CSW.

FENa >1% for volume overloaded SIADH.