Background: Swift diagnosis of emergent large vessel occlusion (ELVO) is essential for prompt intervention in acute ischemic stroke. The Vision, Aphasia, and Neglect (VAN) screening tool has emerged as a viable bedside method for this purpose. This study sought to evaluate the VAN screening tool for the clinical prediction of ELVO in patients presenting to a tertiary centre in Kerala. Aims: To validate the diagnostic accuracy (sensitivity, specificity, positive predictive value, and negative predictive value) of the VAN screening tool in identifying ELVO among acute ischemic stroke patients presenting to a tertiary care centre in Kerala, India. Settings and Design: Emergency Department, IQRAA International Hospital and Research Centre, Calicut, Kerala. Prospective observational study using convenience sampling. Methods and Material: 154 patients with suspected stroke within the thrombectomy window were evaluated using the VAN screening tool. MRI/CT angiography served as the reference standard for diagnosing ELVO. Demographic data, neurological deficit characteristics, VAN score outcomes, and angiographic results were documented. Statistical Analysis Used: Data were analyzed using SPSS version 26. Descriptive statistics (frequencies, percentages) were used for categorical variables. Sensitivity, specificity, PPV, NPV, and diagnostic accuracy were computed. Chi-square test was used to assess association between VAN score and angiography results (significance at p<0.05). Results: Among 154 patients, 35.1% tested positive using VAN, while 32.5% had confirmed ELVO on angiography. VAN demonstrated sensitivity of 78.0%, specificity of 85.6%, PPV of 72.2%, and NPV of 89.7%. The correlation between VAN score and angiographic outcomes was statistically significant (p<0.001). Most participants were male (64.9%) and aged 61–70 years (40.3%). Moderate to severe drift was the most prevalent weakness (48.7%), followed by expressive aphasia (15.6%) and unilateral neglect (11.7%). Conclusions: The VAN screening tool exhibits robust diagnostic efficacy for detecting ELVO in the emergency department. The high specificity and negative predictive value make it advantageous for excluding ELVO, potentially minimising unnecessary advanced imaging in resource-constrained settings. VAN should be integrated into standardised stroke assessment protocols to accelerate triage and enhance therapy pathways.