Clinical decision support that reasons like a neurologist: run the acute-stroke reperfusion clock, stop status epilepticus by the timeline, diagnose and treat multiple sclerosis, and catch the thunderclap headache — with the decision rule and exactly what would change it. Built for verified physicians.
Two real neurology questions, each reasoned the way HeyHippocrates answers: the skills fire, the answer is cited, the decision rule is explicit, and what's missing is flagged. Scroll to each.
Sudden right hemiparesis and aphasia, last known well two hours ago — the acute pathway?
Treat this as an acute stroke and start the clock. Activate the stroke pathway, quantify the deficit with the NIHSS, and get an immediate non-contrast CT to exclude hemorrhage. If the scan shows no bleed and the patient is within 4.5 hours of the last known well with no contraindication, give intravenous thrombolysis — alteplase or tenecteplase. Get CT angiography for a large-vessel occlusion, which is treated with mechanical thrombectomy up to 24 hours in selected patients on perfusion imaging. Manage blood pressure and glucose. Time is brain.
Decision ruleAcute stroke → activate pathway + NIHSS + non-contrast CT (exclude hemorrhage); IV thrombolysis within 4.5 h if no contraindication; CTA for large-vessel occlusion → thrombectomy (up to 24 h selected by perfusion); manage BP and glucose. Time is brain.
Not established from this alone — the CT, the time window and the vessel change the reperfusion decision.
A convulsive seizure now lasting over five minutes — the emergency management?
A convulsive seizure lasting five minutes or more is status epilepticus and a time-critical emergency. Secure the airway, breathing and circulation, check glucose and start timing. Give a first-line intravenous benzodiazepine — lorazepam, or intramuscular midazolam without access — and repeat once. If it continues, load a second-line antiseizure medication such as levetiracetam, valproate or fosphenytoin. Refractory status needs an anesthetic infusion, continuous EEG and intensive care. Throughout, hunt and treat the cause — glucose, electrolytes, drugs, infection or a structural lesion.
Decision ruleConvulsive seizure 5 min or more = status epilepticus → ABCs + glucose + timing; first-line IV benzodiazepine (repeat once); second-line antiseizure (levetiracetam/valproate/fosphenytoin) if continuing; refractory → anesthetic infusion + continuous EEG + ICU; find and treat the cause.
Not established from this alone — the seizure duration, the response and the underlying cause change the escalation.
Illustrative simulations. The physician always decides.
The exact questions your field searches for — answered in the format the knowledge base speaks: the answer, the decision rule, what's missing, and the source.
Move fast and in parallel. Confirm the deficit and the time of last known well, quantify it with the NIHSS, and get an immediate non-contrast CT to rule out hemorrhage before any thrombolysis. Give intravenous alteplase or tenecteplase within 4.5 hours if there is no contraindication, and pursue CT angiography for a large-vessel occlusion, which is treated with mechanical thrombectomy up to 24 hours in patients selected by perfusion imaging. Control blood pressure to the threshold appropriate for the treatment, and correct glucose. Every minute of delay loses neurons.AHA/ASA · stroke
Decision ruleConfirm deficit + last known well + NIHSS + non-contrast CT (no bleed); IV thrombolysis within 4.5 h if eligible; CTA → thrombectomy for large-vessel occlusion (up to 24 h, perfusion-selected); BP threshold by treatment; correct glucose; minimize delay.
Missing data: the time window, the imaging and the contraindications change the reperfusion plan.
Define it early: a convulsive seizure of five minutes or more, or repeated seizures without recovery between, is status epilepticus. In the first five minutes, secure the airway, breathing and circulation, check glucose and start timing. From five to twenty minutes, give a benzodiazepine — intravenous lorazepam or intramuscular midazolam — and repeat once. From twenty to forty minutes, load a second-line agent, levetiracetam, valproate or fosphenytoin. Beyond that, refractory status needs anesthetic infusion, continuous EEG and intensive care, alongside a search for the precipitant.NCS · status
Decision ruleStatus = seizure 5 min or more (or repeated without recovery); 0–5 min ABCs + glucose + timing; 5–20 min benzodiazepine (repeat once); 20–40 min second-line (levetiracetam/valproate/fosphenytoin); refractory → anesthetic + continuous EEG + ICU; treat the cause throughout.
Missing data: the duration, the response to benzodiazepine and the cause change the next step.
Diagnose relapsing-remitting multiple sclerosis with the McDonald criteria, which require dissemination in space and time — typically clinical relapses plus MRI lesions in characteristic locations, supported by cerebrospinal fluid oligoclonal bands — after excluding mimics. Treat an acute relapse with high-dose corticosteroids, and start a disease-modifying therapy early to reduce relapses and disability, matching its efficacy and risk to the disease activity. Follow with periodic MRI and clinical review, and escalate therapy for breakthrough activity.McDonald criteria
Decision ruleMcDonald criteria (dissemination in space + time; MRI + clinical, oligoclonal bands support) after excluding mimics; acute relapse → high-dose steroids; start disease-modifying therapy early, matched to activity and risk; monitor MRI + clinically, escalate for breakthrough.
Missing data: the MRI, the cerebrospinal fluid and the disease course change the diagnosis and the therapy.
Most headaches are primary, so the task is to catch the secondary danger using red flags — the SNNOOP10 set: systemic symptoms or cancer, a neurologic deficit, sudden thunderclap onset, older age at onset, a change in pattern, positional or exertional triggers, papilledema, and pregnancy or immunosuppression. A thunderclap headache reaching maximum in seconds to a minute demands an immediate non-contrast CT and, if negative with ongoing suspicion, a lumbar puncture to exclude subarachnoid hemorrhage. Red flags drive imaging and workup; without them, treat the primary headache.SNNOOP10
Decision ruleRed flags (SNNOOP10: systemic/cancer, neuro deficit, sudden thunderclap, older onset, pattern change, positional/exertional, papilledema, pregnancy/immunosuppression) → imaging + workup; thunderclap → CT then LP for subarachnoid hemorrhage; none → treat the primary headache.
Missing data: the onset, the neurologic exam and the systemic features change the workup.
Your whole practice, one specialist brain — grounded in champion-authored, cited knowledge.
A generalist neurology colleague across acute stroke, seizure and epilepsy, headache, movement disorders, neuroimmunology and neuromuscular disease — cited, non-directive, always with the decision rule.
Deep specialist agents for vascular neurology and stroke, epilepsy, neuroimmunology and multiple sclerosis, and movement disorders — each its own soul and knowledge base — plus your own uploaded materials.
From the reperfusion window to the status timeline the margin is thin. Only one of these reasons like a neurology colleague whose every claim you can trace.
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It reasons in the frameworks you use — the acute-stroke reperfusion pathway, the status-epilepticus timeline, the McDonald criteria and the headache red flags — and always shows the reasoning, the decision rule and what would change it. The decision always stays your call.
Both. Residents use it to pressure-test a plan and learn the decision rule; attendings use it as a fast, cited second opinion on the stroke pager and in clinic. Access is gated to verified physicians.
Vascular neurology and stroke, epilepsy, neuroimmunology and multiple sclerosis, and movement disorders each have their own deep specialist agent on the Pro plan, on top of the full neurology scope on Basic.
No. It is physician-facing clinical decision support — a cited thinking partner. It does not diagnose, does not treat, and gives no patient-facing advice. The decision always stays with you.
Every answer is grounded only in champion-authored, cited neurology knowledge — traceable, not hallucinated — and always states the decision rule plus what data is missing, instead of a confident guess.
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