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For healthcare professionals

VAN Stroke Screen (Vision, Aphasia, Neglect)

VAN is a bedside screen designed to flag a possible large vessel occlusion (LVO) in a patient with a suspected stroke. It starts with arm weakness, then checks for visual disturbance, aphasia and neglect. It has no point score: it is positive or negative. This tool is written for clinicians and EMS. It is not a self-check and not a diagnosis.

Last reviewed: By the uncovermyrisk.com editorial team Educational only, not medical advice.

Stroke signs right now? Call 911.General safety advice (not part of the published screen). Sudden face drooping, arm weakness, trouble speaking, loss of balance or vision changes are emergency signs of stroke: call 911 (CDC). Get emergency care by ambulance, not by driving (NINDS). Do not delay emergency care to complete a screen.

The four findings

Findings as listed by Lima and colleagues (Lima 2019). The short notes under each finding are our own. Nothing you enter leaves this page.

Arm weakness

Weakness of an arm. This is the required first finding.

V: Visual disturbance

Any new visual disturbance.

A: Aphasia

Trouble speaking, finding words or understanding speech.

N: Neglect

The person ignores one side of space or of their own body.

Result appears here

What you will see

VAN positive or negative, and which of visual disturbance, aphasia and neglect were present with arm weakness.

Educational only, not medical advice. A screen, not a diagnosis. Any sudden stroke sign means calling 911.

Source

Teleb MS et al., J Neurointerv Surg 2017 (the original screen, cited only). Findings and rule as printed in three open access (CC BY 4.0) papers: Lima FO et al., Front Neurol 2019; Nicholls JK et al., Front Neurol 2022; Yiang GT et al., Diagnostics 2022.

Validated in

A single pilot study by the developers (Teleb 2017, cited only; see the original paper for the cohort). The performance figures on this page are those printed in an open access review (Nicholls 2022).

Limits

A triage aid for clinicians and EMS, not a diagnosis. A negative screen does not rule out a stroke or an occlusion. It does not tell a stroke from a bleed or a stroke mimic. Vessel imaging decides. Never delay calling 911 to complete it.

How the screen works

VAN has four findings: arm weakness, visual disturbance, aphasia and neglect (Lima 2019). Arm weakness is the must-have first finding, and VAN has no scoring system (Yiang 2022). The screen is positive when the patient has weakness and one of visual disturbances, aphasia or neglect (Nicholls 2022). The screen was described by Teleb and colleagues in a pilot study (Teleb 2017).

Arm weaknessVisual disturbance, aphasia or neglectVAN
PresentAt least one presentPositive
PresentNone presentNegative
AbsentAnyNegative

How well it performed

In the pilot study, the VAN score identified large vessel occlusion patients with 100% sensitivity and 90% specificity, in patients with weakness, one of visual disturbances, aphasia or neglect, and an NIHSS score of ≥6, as reported in a scoping review (Nicholls 2022). These figures come from the first study of the screen (Teleb 2017). Results from one pilot study may not carry over to other settings, so a negative screen does not rule out an occlusion.

Related stroke tools

For a five-item score from 0 to 9 with a cut-off of 4, see FAST-ED. For a five-item score from 0 to 9 with a cut-off of 5, see the RACE scale. For a three-item motor score from 0 to 5 with a cut-off of 4, see the Los Angeles Motor Scale (LAMS). For the three-sign face, arm and speech screen used before hospital, see the Cincinnati Prehospital Stroke Scale. Other bedside scores are listed under For healthcare professionals.

Sources

  1. Teleb MS, Ver Hage A, Carter J, Jayaraman MV, McTaggart RA. Stroke vision, aphasia, neglect (VAN) assessment: a novel emergent large vessel occlusion screening tool: pilot study and comparison with current clinical severity indices. J Neurointerv Surg. 2017;9(2):122-126. doi:10.1136/neurintsurg-2015-012131. PMID 26891627. The original VAN paper (CC BY-NC licence: cited only, not quoted). pmc.ncbi.nlm.nih.gov/articles/PMC5284468/
  2. Lima FO, Mont'Alverne FJA, Bandeira D, Nogueira RG. Pre-hospital Assessment of Large Vessel Occlusion Strokes: Implications for Modeling and Planning Stroke Systems of Care. Front Neurol. 2019;10:955. doi:10.3389/fneur.2019.00955. PMID 31572286. Open access (CC BY 4.0). Table of prehospital scales: VAN items arm weakness, visual disturbance, aphasia, neglect. pmc.ncbi.nlm.nih.gov/articles/PMC6753197/
  3. Nicholls JK, Ince J, Minhas JS, Chung EML. Emerging Detection Techniques for Large Vessel Occlusion Stroke: A Scoping Review. Front Neurol. 2022;12:780324. doi:10.3389/fneur.2021.780324. PMID 35095726. Open access (CC BY 4.0). VAN rule: weakness plus one of visual disturbance, aphasia or neglect; pilot sensitivity 100%, specificity 90%. pmc.ncbi.nlm.nih.gov/articles/PMC8796731/
  4. Yiang GT, Chen YH, Chen PY, Hsiao CL, Lin SK. Rapid Identification of Patients Eligible for Direct Emergent Computed Tomography Angiography during Acute Ischemic Stroke: The DARE-PACE Assessment. Diagnostics. 2022;12(2):511. doi:10.3390/diagnostics12020511. PMID 35204601. Open access (CC BY 4.0). Discussion: VAN has a must-have motor weakness item plus visual disturbance, aphasia and neglect, with no scoring system. pmc.ncbi.nlm.nih.gov/articles/PMC8871088/
  5. Centers for Disease Control and Prevention. Signs and Symptoms of Stroke. www.cdc.gov/stroke/signs-symptoms/index.html
  6. National Institute of Neurological Disorders and Stroke (NIH). Transient Ischemic Attack (TIA). www.ninds.nih.gov/health-information/disorders/transient-ischemic-attack

Written and maintained by the uncovermyrisk.com editorial team. We do not have a medical reviewer; every claim links to its primary source above. Last reviewed: 2026-11-04. Spotted an error? See About.