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    Modified Fisher Grading Scale for Subarachnoid Hemorrhage (SAH)

    States severity of SAH based on amount and type of blood on CT with associated vasospasm risk.
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    BEFORE USE

    This scale only applies to aneurysmal subarachnoid hemorrhage (aSAH).

    • Thin SAH is classified as < 1mm in depth.
    • Thick SAH is classified as ≥ 1mm in depth.

    Clinician must be able to identify subarachnoid hemorrhage (SAH) and major neuroanatomical landmarks on head CT.

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    Advice

    • Neurological and neurosurgical consultation should be obtained for patients with evidence of any SAH on imaging or lumbar puncture, whether the SAH is likely to be aneurysmal or non-aneurysmal in nature.
    • Computed tomographic angiography (CTA) of the head is helpful to determine the presence of a lesion suitable for surgical or endovascular intervention.
    • Consider discussing need for cerebrovascular imaging, such as CTA of the head or catheter angiography, with neurological or neurosurgical consultant before ordering.
    • Similarly, consider deferring the decision to start medications that have been shown to alter outcomes in aSAH (such as nimodipine and/or aminocaproic acid) to the neurological or neurosurgical consultant.
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