Wednesday, March 28, 2018

Emergent Large Vessel Occlusion

R.E.B.E.L.EM - March 27, 2018
"Background: Over the last three years, we have seen the rise of neurointerventional therapies for patients with ischemic strokes due to large vessel occlusions (LVOs). This group of strokes typically includes patients with occlusion of the distal intracranial carotid artery, middle cerebral artery or anterior cerebral artery. Rapid identification of these patients both in the prehospital setting as well as in the emergency department (ED) may be beneficial as it can lead to mobilization of necessary resources and ordering of proper investigations (CT perfusion, MRI/MRA). While there are a number of clinical scoring systems in place to identify patients with LVO, none are ideal. The authors investigate the utility of the vision, aphasia, neglect (VAN) assessment for this purpose.
The VAN assessment (see table below) begins with a simple assessment of upper extremity weakness. If the patient exhibits weakness (minimum is any drift) they then proceed to vision, aphasia and neglect testing. If either vision, aphasia or neglect assessment is abnormal, the patient should be suspected of having a LVO. If there is no weakness, the patient is deemed to not have an LVO and the vision, aphasia and neglect pieces of the assessment are not carried out...
Bottom Line: The VAN assessment is a novel approach to rapid identification of patients with ischemic stroke from potential LVO who may be eligible for endovascular therapy. We await further research prior to making any further recommendations."