From the Guidelines
VAN stands for Vision, Aphasia, and Neglect, which is a clinical assessment tool used to identify patients with large vessel occlusion strokes. When evaluating a potential stroke patient, healthcare providers first check for arm weakness, and if present, they proceed to assess these three specific neurological functions. Vision assessment involves checking for field cuts or blindness in one eye; aphasia testing evaluates the patient's ability to understand and produce language; and neglect testing determines if the patient is aware of both sides of their body and environment. The VAN assessment is valuable because it helps identify patients who may benefit from endovascular thrombectomy, a time-sensitive procedure that can significantly improve outcomes in large vessel occlusion strokes. This screening tool is designed to be quick and efficient, allowing for rapid triage and transfer to appropriate stroke centers when necessary 1.
Key Components of VAN Assessment
- Vision assessment: checking for field cuts or blindness in one eye
- Aphasia testing: evaluating the patient's ability to understand and produce language
- Neglect testing: determining if the patient is aware of both sides of their body and environment
The importance of prompt identification and management of stroke patients is emphasized in the guidelines for the early management of patients with acute ischemic stroke 1. However, the most recent and relevant study on this topic is the Canadian Stroke Best Practice Recommendations, 7th edition practice guidelines update, 2024 1, which highlights the significance of vascular cognitive impairment in stroke patients.
Clinical Significance of VAN Assessment
The VAN assessment is crucial in identifying patients who may benefit from endovascular thrombectomy, a procedure that can significantly improve outcomes in large vessel occlusion strokes. By quickly and efficiently assessing vision, aphasia, and neglect, healthcare providers can make informed decisions about the need for urgent transfer to a stroke center. This is particularly important given the time-sensitive nature of stroke treatment, as emphasized in the guidelines for early management of acute ischemic stroke 1.
In clinical practice, the VAN assessment is a valuable tool for rapidly identifying patients with large vessel occlusion strokes, allowing for prompt initiation of appropriate treatment and improving patient outcomes. The assessment is quick, efficient, and designed to be used in emergency settings, making it an essential component of stroke care 1.
From the Research
Vascular (VAN) Assessment of Neurological Signs
- Vascular (VAN) Assessment of Neurological signs stands for Vision, Aphasia, Neglect Assessment, which is a screening tool used to identify patients with large vessel occlusion stroke 2, 3, 4, 5.
- The VAN assessment is a simple bedside test that evaluates a patient's vision, aphasia, and neglect to predict the need for neurosurgical intervention in patients with intracerebral hemorrhage (ICH) 4.
- The tool has been studied in various settings, including emergency departments and prehospital settings, and has been compared to other stroke severity scales such as the National Institutes of Health Stroke Scale (NIHSS) 2, 3, 5.
- The VAN assessment has been found to have high sensitivity and negative predictive value (NPV) in predicting the need for craniotomy or hematoma evacuation in patients with ICH 4.
- However, the tool has been found to have lower sensitivity for detecting any neurosurgical procedure, and its positive predictive value (PPV) is low for detecting large vessel occlusion (LVO) stroke 5.
Components of VAN Assessment
- Vision: evaluates the patient's visual field and acuity 2, 3, 4, 5.
- Aphasia: evaluates the patient's language and communication skills 2, 3, 4, 5.
- Neglect: evaluates the patient's awareness and attention to their surroundings 2, 3, 4, 5.
Clinical Utility of VAN Assessment
- The VAN assessment can be used to identify patients with LVO stroke who may require urgent neurosurgical intervention 2, 3, 5.
- The tool can also be used to predict the need for neurosurgical intervention in patients with ICH 4.
- However, the VAN assessment should be used in conjunction with other clinical assessments and imaging studies to confirm the diagnosis and guide treatment decisions 2, 3, 4, 5.