Stroke Note Builder (AIS)
A smart note builder for the stroke unit: enter NIHSS, reperfusion, imaging, and etiology; the impression and an evidence-tagged plan write themselves. Copy as Impression/Plan or SOAP.
Reviewed by Zaka Ahmed, MD Clinical reference · 4 min read
Acute Ischemic Stroke — Impression & Plan
Answer what you know at the bedside. The impression and an evidence-tagged plan write themselves and update as you go; switch to SOAP, edit the text, then copy it into your note.
⚠ Do not enter names, dates of birth, MRNs, or any other identifier. Nothing is stored on our servers.Educational documentation aid for clinicians. It applies published guideline logic to what you enter; it does not know your patient. Verify every line, follow your institutional protocol, and use clinical judgment. Full disclaimer.
Assistant (beta)
Type or dictate your one-line impression and the assistant fills the fields above; the plan itself still comes from the rule set, not from the model. No identifiers — the text goes to our own server and on to a language-model provider, and is not stored.
The AI assistant is switched off on this deployment. The builder works fully without it.
My phrases — the builder learns your service
Add the lines your attending always wants ("Neuro checks q2h overnight", "SLP to see before breakfast"). They are saved in this browser only and appended to the section you choose every time you build a note.
Clinical notes & interpretation Scoring guidance, pitfalls, FAQs, and references
Every line in the plan is generated from a stated rule and tagged with the trial or guideline behind it — so the note teaches while it saves time.
- → The antithrombotic default follows the decision most residents get quizzed on: minor stroke within 24 h → DAPT × 21 days (CHANCE, POINT); symptomatic intracranial stenosis → DAPT × 90 days (SAMMPRIS); atrial fibrillation → anticoagulation timed by infarct size (ELAN, OPTIMAS); ESUS → antiplatelet, not empiric DOAC (NAVIGATE-ESUS, RESPECT-ESUS).
- → Reperfusion status changes the whole first section: post-lytic BP and monitoring for 24 h, antithrombotic hold until the 24-hour scan, and after thrombectomy a caution against intensive lowering below SBP 140 (ENCHANTED2/MT, BEST-II).
- → The builder flags inconsistencies — atrial fibrillation with a non-cardioembolic plan, a mechanical valve with a DOAC — instead of silently writing them into your note.
Residents write the same stroke note many times a week, and the failure mode is never the medicine — it is the line that gets dropped at 3 a.m.: the anticoagulation start date, the LDL target, the dysphagia screen before the first pill. Static templates help, but they cannot tell you that this patient with an NIHSS of 2 should be on dual antiplatelet therapy for exactly three weeks, or that that patient's large infarct pushes the DOAC to day 6–14 with a repeat scan first. This builder does. Enter the handful of things you already know from the workup and it assembles a complete, guideline-consistent impression and plan; you read it, change what your patient needs, and paste it.
What the builder decides for you (and what it does not)
It decides only what published guidance decides: monitoring after thrombolysis, blood-pressure thresholds by reperfusion status, the antithrombotic strategy by mechanism and severity, anticoagulation timing by infarct size, statin intensity and LDL goal, VTE prophylaxis, early mobilization, and the follow-up skeleton. It does not decide whether your patient was a thrombolysis candidate, does not score the NIHSS for you (the NIHSS calculator does), and does not know anything you have not typed. Every default is editable, and the "Antithrombotic plan" field overrides the rule set entirely when your attending wants something else.
Impression / Plan or SOAP
Impression/Plan is the default because that is how stroke-unit progress notes are actually written. The SOAP toggle keeps the same plan and adds a Subjective and Objective scaffold with bracketed blanks for the exam, vitals, and imaging you fill in from the chart. Both copy as plain text with clean headings, so they paste into any EHR note without formatting debris. Evidence tags stay out of the copied text unless you switch them on — they are there for you, not for the chart.
Privacy
The builder runs entirely in your browser. Nothing you type is sent anywhere or stored on our servers; the "My phrases" and preference features use your browser's local storage only. If the optional assistant is enabled, the one-line impression you choose to send goes to our own server and on to a language-model provider to fill the fields — which is exactly why the page asks you never to include identifiers. Age and sex are the only patient descriptors the note uses, and both are optional.
Frequently asked questions
Can I save my notes?
No, deliberately. Copy the note into your institution's record; the builder holds nothing. Your saved phrases and default preferences (statin, LDL goal, anticoagulant, BP regimen, note style) do persist in your browser so the next note starts the way your service likes it.
Why does the plan tell me to hold aspirin?
If you marked thrombolysis as given within the last 24 hours, the builder holds all antithrombotics and pharmacologic VTE prophylaxis until follow-up imaging excludes hemorrhage, per AHA/ASA guidance. Switch "Time since lytic" to "≥ 24 h" once the scan is done and the antithrombotic plan appears.
Is this a substitute for my institution's stroke pathway?
No. It is an educational documentation aid that applies published guideline logic to what you enter. Local protocols, drug formularies, and attending preference come first — and every line is editable for exactly that reason.
Which other notes are coming?
TIA, intracerebral hemorrhage, and subarachnoid hemorrhage builders are next, followed by neuro-ICU, on-call consult, and neuro-exam templates. The residents' hub lists what is live.
References
- Powers WJ, et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update. Stroke. 2019;50:e344–e418.
- Kleindorfer DO, et al. 2021 guideline for the prevention of stroke in patients with stroke and TIA. Stroke. 2021;52:e364–e467.
- Wang Y, et al. Clopidogrel with aspirin in acute minor stroke or TIA (CHANCE). N Engl J Med. 2013;369:11–19. · Johnston SC, et al. POINT. N Engl J Med. 2018;379:215–225. · Johnston SC, et al. THALES. N Engl J Med. 2020;383:207–217.
- Chimowitz MI, et al. Stenting versus aggressive medical therapy for intracranial arterial stenosis (SAMMPRIS). N Engl J Med. 2011;365:993–1003.
- Fischer U, et al. Early versus later anticoagulation for stroke with atrial fibrillation (ELAN). N Engl J Med. 2023;388:2411–2421. · Werring DJ, et al. OPTIMAS. Lancet. 2024.
- Hart RG, et al. Rivaroxaban for ESUS (NAVIGATE ESUS). N Engl J Med. 2018;378:2191–2201. · Diener HC, et al. Dabigatran for ESUS (RE-SPECT ESUS). N Engl J Med. 2019;380:1906–1917.
- Amarenco P, et al. High-dose atorvastatin after stroke or TIA (SPARCL). N Engl J Med. 2006;355:549–559. · Amarenco P, et al. A comparison of two LDL cholesterol targets after ischemic stroke (TST). N Engl J Med. 2020;382:9.
- Yang P, et al. Intensive blood pressure control after endovascular thrombectomy (ENCHANTED2/MT). Lancet. 2022;400:1585–1596. · Mistry EA, et al. BEST-II. JAMA. 2023;330:821–831.
- CLOTS Trials Collaboration. Intermittent pneumatic compression in stroke (CLOTS 3). Lancet. 2013;382:516–524. · AVERT Trial Collaboration. Efficacy and safety of very early mobilisation. Lancet. 2015;386:46–55. · Johnston KC, et al. SHINE. JAMA. 2019;322:326–335.
- Saver JL, et al. RESPECT; Mas JL, et al. CLOSE; Søndergaard L, et al. REDUCE. N Engl J Med. 2017;377:1011–1052.