Modified Fisher Grading Scale for Subarachnoid Hemorrhage (SAH)
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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- 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.