The acute stroke note is written at the worst possible time to write anything: mid-code, clock running, decisions stacking up. A good template does not think for you, but it keeps you from forgetting the field that matters — the last-known-well time, the baseline function the outcome will be measured against, the blood-pressure target you set and then need to defend at 3 a.m. This one is organized the way the evaluation actually flows, so it works as a live scaffold, not a form you back-fill later.

Free download

Get the template

Download it now — no email required. If you find it useful, the monthly dispatch below sends tools like this as they are built.

Get the next tool in your inbox

The Vascular Brief — trial updates, clinical tools, and bedside-ready summaries, from a practicing vascular neurologist. One email a month. No spam, ever.

What's inside

The template follows the standard SOAP structure, tuned for acute ischemic stroke:

  • Subjective: reason for consult, last-known-well and discovery time (witnessed vs. wake-up), the deficit and its course, baseline mRS, vascular history, antithrombotic use, a thrombolysis-contraindication screen, medications and allergies.
  • Objective: vitals and fingerstick glucose, NIHSS, general and neurologic exam, key labs (glucose, INR, platelets, renal function), ECG rhythm, and a structured imaging block — NCCT (hemorrhage, ASPECTS, early change, hyperdense vessel), CTA (large-vessel occlusion, carotid disease), CT perfusion (core/penumbra), and MRI if obtained.
  • Assessment: a one-liner summary, suspected TOAST mechanism, and explicit IV-thrombolysis and thrombectomy eligibility lines.
  • Plan: reperfusion decision with time stamp, blood-pressure target and agent, antithrombotic timing, admission and monitoring, diagnostic workup, secondary prevention, supportive care (dysphagia screen, VTE prophylaxis, therapies), and disposition.

A worked example

S: Consulted for sudden right-hand weakness and word-finding difficulty. Last known well 08:00; symptoms noted 08:10, witnessed by spouse. Baseline mRS 0. HTN, hyperlipidemia; not on antithrombotics. No recent surgery, bleeding, or head injury.

O: BP 168/92, HR 88 irregular, glucose 132. NIHSS 6 (mild right facial weakness, right arm drift, mild aphasia). NCCT: no hemorrhage, ASPECTS 10, no early change. CTA: left M2 occlusion. ECG: atrial fibrillation.

A: 72-year-old man with HTN/HLD and newly identified atrial fibrillation, presenting with an NIHSS 6 left-MCA (M2) syndrome, LKW 08:00. Likely cardioembolic (TOAST). Within thrombolysis window, no contraindications; M2 occlusion — thrombectomy candidacy discussed with neurointervention.

P: Tenecteplase given 09:05. BP goal <185/110 pre and <180/105 post. Admit stroke unit, neuro checks q1h × 6h. MRI, echocardiogram, telemetry. Hold antithrombotics 24h post-lytic, then start anticoagulation for atrial fibrillation per timing. Dysphagia screen before PO, VTE prophylaxis, PT/OT/SLP, high-intensity statin. Disposition per recovery.

Documentation pearls

  • Anchor the clock explicitly. Write the last-known-well time and say whether onset was witnessed or a wake-up — "symptom discovery" is not the same clock, and reperfusion eligibility hangs on the difference.
  • Record a baseline. Pre-event mRS turns the outcome into a delta. A note without it makes the recovery impossible to interpret later.
  • Time-stamp the reperfusion decision and the BP target. Future you (and the QI review) will want the exact minute and the exact numbers.
  • Document the contraindications you checked — not just the decision. "Screened, none present" is a stronger note than a bare "tPA given."

Commonly omitted — don't be

  • Baseline functional status (pre-event mRS).
  • Dysphagia screen documented before any oral intake or medication.
  • A specific blood-pressure target and the agent used to reach it.
  • Atrial-fibrillation anticoagulation plan and its timing after reperfusion.
  • A stated suspected mechanism (TOAST) and the etiology workup that follows from it.