Table 1

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.