Abstract 105: Gaze, weakness, neglect and speech (GWNS), an LVO stroke sale is also predictive of distal medium vessel occlusion (DMVO) in the emergency department.

Background and objective In acute ischemic stroke, DMVOs and LVOs are associated with disability and death. There are no stroke scales that predict DMVOs. The objective is to evaluate if the GWNS stroke scale predicts DMVO as it does for LVOs in hyper‐acute state. Methods Consecutive AIS with suspected PLVOs and DMVOs were prospectively enrolled from January 2020 to December 2022. NIHSS and GWNS scale were obtained prior to CTA and DSA. GWNS scale scores range from 0 to 4. We defined DMVO as distal terminal branches of middle cerebral artery (MCA); M2, M3, M4. Internal carotid artery (ICA), terminus and MCA, M1 were defines as PLVOs. Results We have enrolled 148 patients; mean age 68.74+/‐15.37, 52.70% female, GWNS 2 in 32 3 in 35 and 4 in 57. Time to obtain GWNS from arrival was 1.5 minutes (range 1 ‐3) and CTA was 30.3 plus‐minus 9 minutes. PLVOs were present in 61% and DMVOs in 39%. All GWNS scale 3 and 4 had vessel occlusion except in 2; one with seizure and other with formed stroke. None with GWNS scale 2 or less had occlusion. GWNS scale score 4 with gaze deviation were more frequent in PLVOs as opposed to GWNS 3 with gaze preferences, which were more frequent in DMVO. Patients with DVMOs demonstrated a lower NIHSS compared to PLVOs. GWNS 3 or 4 is associated with both PLVOs and DMVOs including M3 and M4. GWNS score predicts DMVO better (0.88) than NIHSS (0.66) irrespective of right or left hemispheric vessels. GWNS score 3/4 with Gage predicts the most for DMVOs (0.9). Conclusions GWNS stroke scale predicts DMVOs in our study. This is the only reported scale for DMVOs in our knowledge. The GWNS scale could be used for early detections of both DMVOs and PLVOs for faster perfusion therapy. Further studies are needed.