Stroke VAN | |
---|---|
How weak is the patient? Raise both arms up | □ Mild (minor drift) |
□ Moderate (severe drift—touches or nearly touches ground) | |
□ Severe (flaccid or no antigravity) | |
□ Patient shows no weakness. Patient is VAN negative | |
(exceptions are confused or comatose patients with dizziness, focal findings, or no reason for their altered mental status then basilar artery thrombus must be considered; CTA is warranted) | |
Visual disturbance | □ Field cut (which side) (4 quadrants) |
□ Double vision (ask patient to look to right then left; evaluate for uneven eyes) | |
□ Blind new onset | |
□ None | |
Aphasia | □ Expressive (inability to speak or paraphasic errors); do not count slurring of words (repeat and name 2 objects) |
□ Receptive (not understanding or following commands) (close eyes, make fist) | |
□ Mixed | |
□ None | |
Neglect | □ Forced gaze or inability to track to one side |
□ Unable to feel both sides at the same time, or unable to identify own arm | |
□ Ignoring one side | |
□ None |
Patient must have weakness plus one or all of the V, A, or N to be VAN positive.
VAN positive patients had 100% sensitivity, 90% specificity, positive predictive value 74%, and negative predictive value 100% for detecting large vessel occlusion.
CTA, CT angiography; VAN, vision, aphasia, and neglect.