What is VAN?
VAN is an acronym for “Vision, Aphasia, Neglect.” It is a screening tool used to quickly detect a specific kind of stroke known as a “Large Vessel Occlusion” (LVO). Unlike other screening tools (e.g. RACE, 3I-SS, LEGS, CPSS), VAN is easy to remember, accurate, and requires no score calculation. The tool tests for three major symptoms of LVO strokes:
Vision: Can the patient see in all directions (up, down, left & right)? Does the patient complain of vision loss?
Aphasia: Is the patient able to speak? Does the patient understand the words being spoken to him/her?
Neglect: Does the patient look only to one side or ignore stimulus to one side of the body?
What is an LVO?
Large Vessel Occlusions are strokes affecting the large arteries in the brain. Due to the area of brain tissue supplied by these large arteries, symptoms can be severe and debilitating. Studies suggest these strokes may benefit from specialized treatment, such as thrombectomy (physically removing the clot to restore blood flow).
Why test for LVO?
While many hospitals are certified as “primary stroke centers,” not all hospitals have the capability to treat Large Vessel Occlusions with neuro-endovascular therapy. Multiple studies have shown neuro-endovascular therapy such as thrombectomy to have better patient centered outcomes for this subset of patients compared to alterplase (tPA) alone.*
How do I use VAN?
How to test for a Large Vessel Occlusion (LVO)
Step 1: Conduct a standard prehospital stroke screening exam.
- Positive Cincinnati Stroke Scale (CONTINUE to Step 2)
- Positive BEFAST (CONTINUE to Step 2)
- Neither (STOP – Stroke screening negative)
Step 2: Weakness – Have the patient hold both arms out straight for 10 seconds.
- Drift (one arm more than the other) (CONTINUE to Step 3)
- Unable to lift one arm (CONTINUE to Step 3)
- No weakness (STOP – VAN negative)
Now you can test for a Large Vessel Occlusion using VAN.
Step 3: Vision disturbance – Have the patient look straight at your nose and test all 4 visual quadrants with your fingers. Ask if the patient is experiencing new double vision or blindness. Test for:
- Inability to see in one or more quadrant
- New double vision or blindness
Step 4: Aphasia – Have the patient name two objects and repeat a simple phrase. Test for:
- Inability to name two objects (example: pen & book)
- Inability to repeat a simple phrase (example: “Today is a sunny day.”)
Step 5: Neglect – Ask the patient to look left and right. Test whether the patient can feel you touching the left arm, right arm, and both arms at the same time. Test for:
- Forced gaze to one side
- Ignoring or unable to feel one side
VAN is POSITIVE if the patient has ANY of the symptoms listed in steps 3, 4 or 5.
Review the videos below to learn how the VAN screening test is performed and to better understand and identify aphasia.
In the ODEMSA region, the stroke protocol requires providers to conduct either a Cincinnati Prehospital Stroke Scale (CPSS) or FAST screening exam, and if positive, also conduct a VAN screening.
In the ODEMSA region, VAN has been adopted to direct appropriate patients to hospitals able to provide endovascular therapy.
For full continuing education credit, watch the following video and take the TEST. If you would like to review the fundamentals of stroke, please continue on to Stroke Basics.