Vision, aphasia, neglect emergent large vessel occlusion screening tool
| 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.