Hijdra Sum Score (SAH Blood Burden)
The HIJDRA SUM SCORE (Hijdra and colleagues 1990) quantifies blood on the INITIAL CT after subarachnoid hemorrhage.
Open the calculator → Runs in your browser. Data leaves only if you deliberately send a problem report from the interactive tool.
Example
- Interhemispheric fissure
- 2
- Sylvian fissure, lateral part - left - CISTERN
- 1
- Sylvian fissure, lateral part - right - CISTERN
- 1
- Sylvian fissure, basal part - left - CISTERN
- 2
- Sylvian fissure, basal part - right - CISTERN
- 2
- Suprasellar cistern - left - CISTERN
- 3
- Suprasellar cistern - right - CISTERN
- 3
- Ambient cistern - left - CISTERN
- 1
- Ambient cistern - right - CISTERN
- 1
- Quadrigeminal cistern
- 0
The other 4 values
- Frontal horn of the lateral ventricle - left - VENTRICLE
- 1
- Frontal horn of the lateral ventricle - right - VENTRICLE
- 1
- Third ventricle
- 0
- Fourth ventricle
- 0
Result: 18
The tool opens with these values already filled in. Replace them with your own.
What the result means
- Cistern levels
- 0 no blood; 1 small amount; 2 moderately filled; 3 completely filled.
- Ventricle levels
- DIFFERENT WORDING: 0 no blood; 1 sedimentation of blood in the posterior part; 2 partly filled; 3 completely filled.
- Anchors
- Only 0 and 3 mean the same in both halves. A point in a cistern is not a point in a ventricle, yet they are summed.
- Paired sites
- 8 of the 10 cisternal sites are paired, so there are only 6 named structures. Scoring the sylvian fissure once instead of left and right halves four sites.
- Midline
- Only the interhemispheric fissure and the quadrigeminal cistern are scored once. The third and fourth ventricles likewise.
- Bands
- NONE. The instrument has no official severity bands and none is applied.
- Thresholds
- REPORTED, NOT APPLIED: single studies give 19 or below as a limited clot burden and 23 or above as predicting vasospasm.
- Outcome
- Modified Fisher led for VASOSPASM (AUC 0.78 against 0.68 and 0.62), but only this score correlated with radiological DELAYED CEREBRAL ISCHEMIA. The ranking flips.
- Scope
- Quantifies blood on the initial CT. Does not diagnose SAH, locate or grade an aneurysm, measure clinical severity, or decide vasospasm treatment.
What you enter
- Interhemispheric fissure - CISTERN.
- Sylvian fissure, lateral part - left - CISTERN.
- Sylvian fissure, lateral part - right - CISTERN.
- Sylvian fissure, basal part - left - CISTERN.
- Sylvian fissure, basal part - right - CISTERN.
- Suprasellar cistern - left - CISTERN.
- Suprasellar cistern - right - CISTERN.
- Ambient cistern - left - CISTERN.
- Ambient cistern - right - CISTERN.
- Quadrigeminal cistern - CISTERN.
The other 4 fields
- Interhemispheric fissure - CISTERN. [0 = No blood; 1 = Small amount of blood; 2 = Moderately filled with blood; 3 = Completely filled with blood] Midline - scored once.
- Sylvian fissure, lateral part - left - CISTERN. [0 = No blood; 1 = Small amount of blood; 2 = Moderately filled with blood; 3 = Completely filled with blood] PAIRED - score left and right separately.
- Sylvian fissure, lateral part - right - CISTERN. [0 = No blood; 1 = Small amount of blood; 2 = Moderately filled with blood; 3 = Completely filled with blood] PAIRED - score left and right separately.
- Sylvian fissure, basal part - left - CISTERN. [0 = No blood; 1 = Small amount of blood; 2 = Moderately filled with blood; 3 = Completely filled with blood] PAIRED - score left and right separately.
- Sylvian fissure, basal part - right - CISTERN. [0 = No blood; 1 = Small amount of blood; 2 = Moderately filled with blood; 3 = Completely filled with blood] PAIRED - score left and right separately.
- Suprasellar cistern - left - CISTERN. [0 = No blood; 1 = Small amount of blood; 2 = Moderately filled with blood; 3 = Completely filled with blood] PAIRED - score left and right separately.
- Suprasellar cistern - right - CISTERN. [0 = No blood; 1 = Small amount of blood; 2 = Moderately filled with blood; 3 = Completely filled with blood] PAIRED - score left and right separately.
- Ambient cistern - left - CISTERN. [0 = No blood; 1 = Small amount of blood; 2 = Moderately filled with blood; 3 = Completely filled with blood] PAIRED - score left and right separately.
- Ambient cistern - right - CISTERN. [0 = No blood; 1 = Small amount of blood; 2 = Moderately filled with blood; 3 = Completely filled with blood] PAIRED - score left and right separately.
- Quadrigeminal cistern - CISTERN. [0 = No blood; 1 = Small amount of blood; 2 = Moderately filled with blood; 3 = Completely filled with blood] Midline - scored once.
- Frontal horn of the lateral ventricle - left - VENTRICLE, DIFFERENT WORDING FROM THE CISTERNS. [0 = No blood; 1 = Sedimentation of blood in the posterior part; 2 = Partly filled with blood; 3 = Completely filled with blood] PAIRED - score left and right separately.
- Frontal horn of the lateral ventricle - right - VENTRICLE, DIFFERENT WORDING FROM THE CISTERNS. [0 = No blood; 1 = Sedimentation of blood in the posterior part; 2 = Partly filled with blood; 3 = Completely filled with blood] PAIRED - score left and right separately.
- Third ventricle - VENTRICLE, DIFFERENT WORDING FROM THE CISTERNS. [0 = No blood; 1 = Sedimentation of blood in the posterior part; 2 = Partly filled with blood; 3 = Completely filled with blood] Scored once.
- Fourth ventricle - VENTRICLE, DIFFERENT WORDING FROM THE CISTERNS. [0 = No blood; 1 = Sedimentation of blood in the posterior part; 2 = Partly filled with blood; 3 = Completely filled with blood] Scored once.
How this is calculated
- Structure
- A SUM ACROSS 14 SITES, NOT A GRADE: 10 cisterns and fissures (0 to 30) plus 4 ventricles (0 to 12), total 0 to 42.
Hijdra A, Brouwers PJAM, Vermeulen M, van Gijn J. Grading the amount of blood on computed tomograms after subarachnoid hemorrhage. Stroke. 1990;21(8):1156-1161. Read the source ↗
A reference and educational tool. Not medical, legal, or financial advice, and not a substitute for clinician judgment.