ConsultNeuro

A neurology consultant, trained on published guidelines.

Workup, differential, and management. Answers are drawn from published guidelines, and the sources are named.

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See it in action

Acute stroke

You

A 68-year-old man was last known well 90 minutes ago. He has aphasia and a right hemiparesis, NIHSS 14. CT shows no hemorrhage. Blood pressure is 178/96. What do you do first?

ConsultNeuro

He is inside the window for intravenous thrombolysis, the deficit is disabling, and the CT shows no blood. If standard exclusions are absent, give intravenous thrombolysis now — alteplase or tenecteplase, per the stroke protocol. Do not hold the bolus for a CTA.

Blood pressure is 178/96, already under 185/110, so it does not need to be lowered first. With an NIHSS of 14, obtain CTA of the head and neck as soon as the bolus is running. An intracranial large-vessel occlusion at 90 minutes is a reason to activate thrombectomy in parallel.

Hold antiplatelets and anticoagulation for 24 hours after thrombolysis, and repeat imaging before they are started. Secondary prevention after that follows the stroke and TIA guideline — mechanism, antithrombotic choice, and risk-factor treatment — and it is a separate decision from this first hour.

Sources

  • 2026 AHA/ASA Early Management of Acute Ischemic Stroke
  • 2021 AHA/ASA Prevention of Stroke in Patients With Stroke and TIA

Migraine prevention

You

A 34-year-old woman has about 8 migraine days a month. Rizatriptan works, but she is missing work. No asthma, no hypertension. She may want a pregnancy in the next year. Should I start prevention, and with what?

ConsultNeuro

Diagnosis

Eight migraine days a month, with missed work, is a reason to start prevention rather than rely on acute treatment alone.

Options

  • Propranolol or metoprolol fits this history: no asthma, and blood pressure is not a problem.
  • Do not start topiramate or valproate while pregnancy is possible.
  • If an oral preventive fails or is not acceptable, a CGRP monoclonal antibody is a reasonable next step. Stop it well before a planned pregnancy; the half-life is long.

Recommendation

  1. Start a beta blocker and give it a real trial — on the order of two months at a dose she tolerates — before calling it a failure.
  2. Count days of rizatriptan use. Prevention is difficult to interpret once acute medication is near overuse.

Sources

  • AAN/AHS Pharmacologic Treatment for Migraine Prevention in Adults
  • AAN Episodic Migraine Prevention in Adults

Covers the full breadth of neurology

500+ guidelines and scientific statements, across the subspecialties of clinical neurology.

  • Stroke and cerebrovascular disease
  • Epilepsy
  • Neuromuscular disease
  • Headache and migraine
  • Multiple sclerosis and neuroimmunology
  • Movement disorders
  • Dementia and cognitive disorders
  • Neurocritical care
  • Sleep neurology
  • Neuro-ophthalmology
  • Neuro-oncology
  • Autonomic disorders
  • Pediatric neurology
  • Behavioral neurology
  • Neuroinfectious disease

Grounded in guidelines from leading societies

Published guidance from leading societies, together with open-access literature.

  • AANAmerican Academy of Neurology
  • AHA/ASAAmerican Heart and Stroke Associations
  • AANEMNeuromuscular and Electrodiagnostic Medicine
  • ILAEInternational League Against Epilepsy
  • AHSAmerican Headache Society
  • PubMedNational Library of Medicine