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Endovascular treatment of middle cerebral artery aneurysms with detachable coils: angiographic and clinical outcomes in 115 consecutive patients. Neurosurgery 2009; 64:876. Topic 90190 Version 13.0 https://www.uptodate.com/contents/treatment-of-cerebral-aneurysms/print 14/19 7/7/23, 11:36 AM Treatment of cerebral aneurysms - UpToDate GRAPHICS Hunt and Hess grading system for patients with subarachnoid hemorrhage Grade Neurologic status 1 Asymptomatic or mild headache and slight nuchal rigidity 2 Severe headache, stiff neck, no neurologic deficit except cranial nerve palsy 3 Drowsy or confused, mild focal neurologic deficit 4 Stuporous, moderate or severe hemiparesis 5 Coma, decerebrate posturing Based upon initial neurologic examination. Adapted from: Hunt W, Hess R. Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg 1968; 28:14. Graphic 69179 Version 5.0 https://www.uptodate.com/contents/treatment-of-cerebral-aneurysms/print 15/19 7/7/23, 11:37 AM Treatment of cerebral aneurysms - UpToDate Glasgow Coma Scale (GCS) Score 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 Total The GCS is scored between 3 and 15, 3 being the worst and 15 the best. It is composed of three parameters: best eye response (E), best verbal response (V), and best motor response (M). The components of the GCS should be recorded individually; for example, E2V3M4 results in a GCS score of 9. A score of 13 or higher correlates with mild brain injury, a score of 9 to 12 correlates with moderate injury, and a score of 8 or less represents severe brain injury. Graphic 81854 Version 9.0 https://www.uptodate.com/contents/treatment-of-cerebral-aneurysms/print 16/19 7/7/23, 11:37 AM Treatment of cerebral aneurysms - UpToDate Clip ligation of cerebral aneurysm Left panel: Anteroposterior cerebral angiogram demonstrating a basilar summit aneurysm. Right panel: Postoperative cerebral angiogram demonstrating clip ligation of the lesion with preserved parent vessel patency. Courtesy of Guy Rordorf, MD. Graphic 68084 Version 3.0 https://www.uptodate.com/contents/treatment-of-cerebral-aneurysms/print 17/19 7/7/23, 11:37 AM Treatment of cerebral aneurysms - UpToDate Aneurysm before and after therapy Towne projection of an aneurysm of the right posterior cerebral artery before (left panel) and after (right panel) successful coil embolization. Courtesy of Guy Rordorf, MD. Graphic 80064 Version 3.0 https://www.uptodate.com/contents/treatment-of-cerebral-aneurysms/print 18/19 7/7/23, 11:37 AM Treatment of cerebral aneurysms - UpToDate Contributor Disclosures Robert J Singer, MD No relevant financial relationship(s) with ineligible companies to disclose. Christopher S Ogilvy, MD Consultant/Advisory Boards: Cerevasc [Hydrocephalus]; Contour [Aneurysms]; Medtronic [Chronic subdural hematoma]. All of the relevant financial relationships listed have been mitigated. Guy Rordorf, MD No relevant financial relationship(s) with ineligible companies to disclose. Jos Biller, MD, FACP, FAAN, FAHA No relevant financial relationship(s) with ineligible companies to disclose. Richard P Goddeau, Jr, DO, FAHA No relevant financial relationship(s) with ineligible companies to disclose. Contributor disclosures are reviewed for conflicts of interest by the editorial group. When found, these are addressed by vetting through a multi-level review process, and through requirements for references to be provided to support the content. Appropriately referenced content is required of all authors and must conform to UpToDate standards of evidence. Conflict of interest policy https://www.uptodate.com/contents/treatment-of-cerebral-aneurysms/print 19/19