Archives of Academic Emergency Medicine. 2023; 11(1): e20 OR I G I N A L RE S E A RC H Pattern of Neurological Disorders among Patients Eval- uated in the Emergency Department; Cross–Sectional Study Mohamed Sheikh Hassan1∗, Nor Osman Sidow1, Alper Gökgül1, Bakar Ali Adam1, Mohamed Farah Osman1, Hussein Hassan Mohamed2, Ismail Gedi Ibrahim3, Ishak Ahmed Abdi4 1. Department of Neurology, Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, Somalia. 2. Department of Emergency Medicine, Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, Somalia. 3. Department of Radiology, Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, Somalia. 4. Department of Cardiology, Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, Somalia. Received: October 2022; Accepted: December 2022; Published online: 21 January 2023 Abstract: Introduction: Neurologic disorders are common reasons for emergency consultations. Most neurologic disorders seen in the emergency department (ED) are life-threatening and require urgent treatment. The goal of this study is to investi- gate the pattern of neurological disorders among patients evaluated in the ED. Methods: This is a cross-sectional study conducted in the ED of Mogadishu Somali Turkish Training and Research Hospital, from July 2021 to February 2022. The clinical and epidemiological characteristics of adult patients with neurologic manifestations in the ED were evaluated. Age, gender, distribution of neurological disease manifestations, neurological examination findings, and neurological diagnoses made by consultant neurologists were assessed. Results: During the study period, 321 patients were assessed (3.7% of all ED admissions). The majority of the patients in the study were above 50 years of age (62.6% male). Hyper- tension was the most common comorbidity among these patients with 122 (38%) cases, followed by diabetes mellitus with 65 (20.2%), and heart diseases with 26 (8.1%) cases. The main reasons for neurology consultations were altered mental status with 141 (44%) cases, motor weakness with 102 (31.8%), seizures with 33 (10%), headache with 17 (5.3%), and vertigo with 9 (2.8%) cases. 196 (61%) had hemiplegia, 60 (18.7%) had consciousness impairment, and 38 (11.8%) had normal neurological examination. The most frequent neurological diagnoses were ischemic strokes with 125 (39%) cases, hemorrhagic strokes with 65 (20.2%), epileptic seizures with 28 (8.7%), and metabolic encephalopathies with 13 (4%) cases. The median duration of the neurology consultations was 20 minutes. 251 (78%) of the patients were ad- mitted to the hospital, while 70 (22%) were discharged from the emergency department. After neurology consultation, the neurology department made the most admissions with 226 (90%) cases, while 25 (10%) were admitted by other de- partments. Of those admitted, 186 (74.2%) were admitted to the neurology ward, and 65 (25.8%) were admitted to the intensive care unit. Conclusion: In our study, neurologic emergencies accounted for 3.7% of all emergency admissions. Stroke, epileptic seizures, cerebral venous thrombosis, encephalopathies, and acute spinal cord diseases were the most common neurological disorders. The admission rate was very high following neurologic assessment by neurologists. Keywords: Nervous system diseases; stroke; emergency service, hospital; comorbidity; Somalia Cite this article as: Sheikh Hassan M, Osman Sidow N, Gökgül A, Ali Adam B, Farah Osman M, Hassan Mohamed H, Gedi Ibrahim I, Ahmed Abdi I. Pattern of Neurological Disorders among Patients Evaluated in the Emergency Department; Cross–Sectional Study. Arch Acad Emerg Med. 2023; 11(1): e20. https://doi.org/10.22037/aaem.v11i1.1813. ∗Corresponding Author: Mohamed Sheikh Hassan; Department of Neu- rology, Mogadishu Somali Turkish Training and Research Hospital, Mo- gadishu, Somalia. Tel: +252615609080, Email:dr.m.qalaf@gmail.com, ORCID: https://orcid.org/000-0001-7236-1524. 1. Introduction Neurological disorders comprise 9% of total emergency de- partment (ED) admissions (1). The majority of neurological emergencies are life-threatening conditions that necessitate immediate diagnosis and treatment. If not recognized and treated early, they can have catastrophic effects, resulting in long-term impairment or death (2). Patients presenting to EDs with neurological diseases should be examined as soon This open-access article distributed under the terms of the Creative Commons Attribution NonCommercial 3.0 License (CC BY-NC 3.0). Downloaded from: https://journals.sbmu.ac.ir/aaem/index.php/AAEM/index M. Sheikh Hassan et al. 2 as possible and managed in a multidisciplinary manner, as some of these disorders are associated with other medical and non-medical conditions (3). As demonstrated by a study in the United Kingdom, 10% of ED admissions have at least one neurological complaint, 10%–20% of acute hospitalizations are for neurological dis- orders, and 8–15% of all patients admitted to the ED re- quire a neurologist’s evaluation (4). Cerebrovascular dis- eases, epileptic seizures, central nervous system (CNS) in- fections, encephalopathies, and myelopathies are the com- monest neurological disorders admitted to the ED (5). In one study in Ethiopia, neurological emergencies accounted for 5.27% of the total medical emergencies. Hemiparesis, altered mental status, and seizures were the most common neuro- logical presentations, accounting for 44%, 19.3%, and 13.1% of all cases, respectively. Cerebrovascular disorders (54%), HIV/AIDs related neurologic sequels (9%), meningitis (8.7%), and seizures (7%) were the most common neurologic disor- ders diagnosed (6). Somalia is a developing country with limited medical re- sources. The provision of high-standard healthcare is limited by a lack of human resources, mainly trained health profes- sionals for the management of diseases. Due to the lack of sufficient neurologists in the country, the majority of neuro- logical disease manifestations in EDs are evaluated by non- neurologists, mainly by general practitioners. There is no previous data on the epidemiological profile of patients with neurological emergencies in the ED in Soma- lia. Our objective is to evaluate the demographic character- istics, clinical profile, and neurologic disease pattern among patients evaluated in the ED of a tertiary care hospital in Mo- gadishu, Somalia. 2. Methods 2.1. Study design and settings This is a cross-sectional study conducted in the ED of Mo- gadishu Somali Turkish Training and Research Hospital, Mo- gadishu, Somali, between July 2021 and February 2022. The study was reviewed and accepted by the ethics committee of Mogadishu Somali Turkish Training and Research Hospi- tal (Ethics Protocol No: MSTH/7128, Decision No: 410). In- formed consent was obtained from all eligible patients or their legal representatives. We adhered to all the principles of the Helsinki Declaration. 2.2. Participants This study included all adult patients who were brought to the ED and required neurological assessment by neurologists in the hospital between July 2021 and February 2022. Chil- dren and patients with conversion disorders were excluded from the study. Table 1: Baseline characteristics of studied patients Variable Number (%) Age (years) 20-40 78 (24.3) 40-60 92 (28.7) > 60 150 (46.7) Gender Male 201 (62.6) Female 120 (37.4) Comorbidities Hypertension 122 (38.0) Diabetes mellitus 65 (20.2) Stroke 9 (2.8) Heart disease 26 (8.1) Epilepsy 8 (2.5) Respiratory disease 4 (1.2) Cancer 4 (1.2) Metabolic condition 5 (1.6) Without comorbidity 78 (24.3) Clinical findings Hemiplegia 196 (61.1) Consciousness Impairment 60 (18.7) Paraplegia/Quadriplegia 10 (3.1) Cranial neuropathy 5 (1.6) Aphasia/Dysarthria 4 (1.2) Cerebellar dysfunction 4 (1.2) Hyperkinetic movement disorder 3 (0.9) Autonomic dysfunction 1 (0.3) Normal neurologic examination 38 (11.8) 2.3. Data gathering The data was gathered by a team of neurology specialists and residents in collaboration with emergency physicians. Pa- tients’ demographic characteristics, co-morbidities, presen- tations of neurological diseases in the ED, neurological ex- amination findings, neurological diagnoses made by neurol- ogists, and admission status were evaluated. The neurologi- cal diagnosis was made based on clinical, radiological (com- puted tomography, magnetic resonance imaging, and Elec- troencephalography/Electromyography) findings, and other laboratory investigations according to the ICD-10 codes. To avoid bias in patient selection, a team of expert physicians, including emergency, neurology, and radiology physicians did collaborative work to ensure correct patient selection and proper diagnosis. 2.4. Statistical analyses Data was analyzed using SPSS (Statistical Package for So- cial Sciences, IBM Inc., Chicago, IL, USA) v26.0. Descriptive statistics were used to summarize the data; categorical vari- ables were summarized as counts and percentages. The Pear- son chi-square test was used for the evaluation of categorical data, and the Mann–Whitney test was used for the evaluation This open-access article distributed under the terms of the Creative Commons Attribution NonCommercial 3.0 License (CC BY-NC 3.0). Downloaded from: https://journals.sbmu.ac.ir/aaem/index.php/AAEM/index 3 Archives of Academic Emergency Medicine. 2023; 11(1): e20 of quantitative data. The level of significance was chosen as a p-value < 0.05. 3. Results 3.1. Baseline characteristics of studied patients Out of 8,500 patients admitted to the ED during the study period, 321 patients had neurological manifestations requir- ing neurological evaluation, representing 3.7% of total ED admissions. 189 (59%) patients were above 50 years of age (62.6% male). Table 1 shows the baseline characteristics of studied patients. Co-morbidities were present in about 243 (76%) of the cases. Hypertension was the most common co- morbidity among these patients with 122 (38%) cases, fol- lowed by diabetes mellitus with 65 (20.2%), and heart dis- eases with 26 (8.1%) cases. Cranial or spinal diagnostic imag- ing was done in 273 (85%) of the cases. Computed tomogra- phy was the most common imaging modality used for evalu- ating these patients. 3.2. Clinical characteristics of patients Regarding the main reasons for neurology consultations, 141 (44%) were consulted due to altered mental status, 102 (31.8%) for motor weakness, 33 (10%) for seizures, 17 (5.3%) for headache, 9 (2.8%) for vertigo, 8 (2.5%) for speech impair- ment, 5 (1.6%) due to acute vision loss, and 4 (1.2%) for invol- untary movement, while gait impairment and syncope each led to 1 (0.3%) each consultation. On neurological examina- tion, 196 (61%) had hemiplegia, 60 (18.7%) had conscious- ness impairment, 4 (1.2%) had aphasia/dysarthria, 5 (1.6%) had cranial nerve palsy, 4 (1.2%) had cerebellar dysfunction, 10 (3.1%) had paraplegia, and 38 (11.8%) had normal neuro- logical examination. 3.3. Neurological diagnoses The most frequent neurological diagnoses were ischemic strokes with 125 (39%) cases, hemorrhagic strokes with 65 (20.2%), epileptic seizures with 28 (8.7%), and metabolic en- cephalopathy with 13 (4%) cases (Table 2). Cerebrovascular disorders were more common in older patients compared to young patients (63% vs. 37%; p = 0.001). In contrast, seizure disorders were more common in young patients than in older patients (68% vs. 32%; p = 0.001). Hospital admission was more common in older patients compared to young patients (p = 0.032). One of the most common reasons for neurol- ogy consultation was altered mental status. Among subjects evaluated due to consciousness impairment, 86 (42%) had ischemic stroke, 65 (31.7%) had hemorrhagic stroke, and 20 (9.7%) were diagnosed with epilepsy (table 2). Table 2: Neurologic Diagnoses among the evaluated patients Variable Number (%) Among all cases Ischemic stroke 125 (39.0) Hemorrhagic stroke 65 (20.2) Epilepsy 28 (8.7) Metabolic encephalopathy 13 (4.0) Cerebral venous thrombosis 12 (3.7) Primary headache 11 (3.4) Acute spinal cord disease 10 (3.1) Subarachnoid hemorrhage 8 (2.5) Benign paroxysmal positional vertigo 7 (2.2) Hypertensive encephalopathy 6 (1.9) Delirium 6 (1.9) Guillain-Barre syndrome 4 (1.3) Movement disorder 4 (1.3) Meningitis 3 (0.9) Demyelinating disease 3 (0.9) CNS neoplasm 2 (0.6) Psychiatric disease 1 (0.3) Unspecified CN palsy 1 (0.3) Brain abscess 1 (0.3) Motor neuron disease 1 (0.3) No definitive diagnosis 6 (1.8) Among cases with impaired consciousness Ischemic stroke 86 (4.2) Hemorrhagic stroke 65 (31.7) Epilepsy 20 (9.7) Metabolic encephalopathy 10 (4.87) Central venous thrombosis 7 (3.4) Delirium/Dementia 6 (3.0) Subarachnoid hemorrhage 3 (1.48) Drug intoxication 1 (0.48) Hypertensive encephalopathy 1 (0.48) Intracranial mass 1 (0.48) Meningitis 2 (0.97) Brain abscess 1 (0.48) Subdural hemorrhage 1 (0.48) Undiagnosed 1 (0.48) CNS: central nervous system; CN: cranial nerve. 3.4. Disposition The median duration of the neurology consultations was 20 minutes. 251 (78%) patients were admitted to the hospital, while 70 (22%) were discharged from the emergency depart- ment. After neurology consultation, the neurology depart- ment made most of the admissions with 226 (90%) cases, while 25 (10%) were admitted by other departments. Of those admitted, 186 (74.2%) were admitted to the neurology ward, and 65 (25.8%) were admitted to the intensive care unit. 4. Discussion The findings showed that 3.7% of patients admitted to ED had neurological complaints. Hemorrhagic and ischemic This open-access article distributed under the terms of the Creative Commons Attribution NonCommercial 3.0 License (CC BY-NC 3.0). Downloaded from: https://journals.sbmu.ac.ir/aaem/index.php/AAEM/index M. Sheikh Hassan et al. 4 strokes were the most prevalent neurological presentations, followed by epileptic seizures, cerebral venous thrombosis, encephalopathies, and acute spinal cord diseases. The ma- jority of patients with neurological manifestations were ad- mitted to the neurology department. Neurological disorders are responsible for more than 20% of the world’s burden of disease. Neurological and psychiatric disorders are responsible for up to 28% of all years of life lived with disability. Neurologic emergencies contributed to 92 million disability-adjusted life years in 2005 and were pre- dicted to be 103 million in 2030. The burden of these diseases is higher in developing countries, which constitute about 85% of the world’s population (7, 8). Neurological disorders account for nearly a quarter of all the years of life spent dis- abled. In 2005, neurological emergencies resulted in 92 mil- lion disability-adjusted life years, with a potential increase to 103 million by 2030. A significant portion of patients in the ED may have life- threatening neurological diseases that would quickly dete- riorate if not diagnosed and treated rapidly. However, the vast majority of these patients are not evaluated by neurol- ogists (9). Neurological emergencies are defined by certain features, including rapid onset, the need for immediate as- sessment, diagnosis, and intervention, and the propensity to cause immediate life-threatening situations or long-term disability (10). Because of the shortage of neurology special- ists in our country, the majority of patients with neurological emergencies do not have access to neurological evaluation by neurologists. As a result, these patients are assessed by generalists or internists in the ED. In addition, the propor- tion of neurologic patients in the ED and their diagnosis and disease patterns had never been studied in the country be- fore. As demonstrated by a cross-sectional study conducted in Turkey, the mean age of neurologic patients evaluated in the ED was 63.14 ± 18.61 years. Male patients comprised 50.7% of the subjects, while female subjects comprised 49.3% (11). According to Marcos C. Lange, Vera L. Braatz, and Carolina Tomiyo et al., the mean age of neurologic patients in the ED was 58 years. 60% of the subjects were female, while 40% were male (12). In our study, most patients were 50 years of age or older (59%). The gender distribution of the study population showed no significant differences, which is con- sistent with previous studies. Comorbidities are common in patients with neurological presentations because of the fact that common neurological disorders become more prevalent with increase in age (13). Our study showed that 76% of subjects had associated co- morbidities. Hypertension was the most common associated comorbidity seen in 38% of the patients, followed by diabetes mellitus, previous history of stroke, heart disease, epilepsy, cancer, respiratory disease, and other metabolic conditions. The findings were similar to those of a study by Ufuk Emre and his colleagues, which showed that hypertension, previ- ous stroke, diabetes mellitus, chronic obstructive pulmonary disease, epilepsy, and cancer were the most common comor- bidities (11). As shown by previous studies, neurological complaints were observed in 2% to 10% of patients admitted to the ED. In one study conducted in Brazil, 10% of cases admitted to the ED had neurological presentations [10)(14)Another study in Turkey found that 6% of emergency admissions were due to neurological disorders (15). As per a study in Ethiopia, 10.8% of ED admissions had neurological emergencies (16). In our study, 3.7% of emergency admissions had neurological pre- sentations. 78% of these patients with neurological disorders were admitted to the hospital. This high proportion should be taken into account during emergency medicine and neu- rology training programs, with the goal of increasing hospi- tal staff’s capacity to diagnose and treat these common neu- rological disorders. Our study also showed that 85% of the cases had at least one cranial or spinal diagnostic imaging. Tomography was the most common imaging modality used for evaluating these patients. This indicates the importance of imaging in the diagnosis of neurological diseases. A study in the UK performed by Carroll and Zajicek demon- strated that the main neurological presentations in the ED requiring neurology consultation were weakness (40%), headache (24%), and seizures (15%). Stroke, headaches, and seizures were the three most common ED admissions and accounted for 53% of cases (14). Another study conducted in a referral hospital in Bangladesh showed that stroke was the most common condition (47.5%), followed by seizure (9.3%), disease of the spinal cord (7.8%), and encephalopa- thy (6.3%) (17). In our study, the main reason for neurol- ogy consultations was impaired consciousness 141 (43.9%), followed by motor weakness 102 (31.8%), seizure 33 (10.3%), and headache 17 (5.3%). This is consistent with the findings that the most common neurological disorders diagnosed in the ED are strokes, seizures, and headache disorders. In the present study, the most common neurological exam- ination findings were motor deficit, consciousness impair- ment, speech impairment, cranial nerve palsy, cerebellar sys- tem dysfunction, abnormal movement disorder, and auto- nomic dysfunction. These findings are consistent with the fact that cerebrovascular diseases are the most common rea- son for neurology consultation. This is similar to the findings of another study by Sevilay Vural and her colleagues, which also showed that motor deficit, speech disorder, conscious- ness impairment, facial asymmetry, and sensory system dys- function were the major neurological findings on examina- tion in those subjects (18). In our study, among the evaluated patients, ischemic and hemorrhagic strokes were the most common neurologic di- This open-access article distributed under the terms of the Creative Commons Attribution NonCommercial 3.0 License (CC BY-NC 3.0). Downloaded from: https://journals.sbmu.ac.ir/aaem/index.php/AAEM/index 5 Archives of Academic Emergency Medicine. 2023; 11(1): e20 agnoses, with 38.9% and 20.2%, respectively. Other common diagnoses among these patients included epilepsy (8.7%), cerebral venous thrombosis (3.7%), metabolic encephalopa- thy (4%), and acute spinal cord disease (3.1%). The distri- bution of diagnoses among the patients in the ED requiring neurology consultation varies from one study to another. In one study in Ethiopia, cerebrovascular diseases, meningitis, and seizure disorders were the most common neurological disorders in the ER (16). In another study in Nigeria, the main neurologic diagnoses were stroke, central nervous system (CNS) infections, and myelopathies (19). In another study conducted in Cameroon, Malaria and other related central nervous system infections, which are endemic to sub-Saharan African countries, were the most common non-traumatic neurological causes in the ED (20). Nevertheless, CNS infections account for a smaller number of patients in emergency admissions in developed countries (18). Although Somalia is a sub-Saharan African nation, CNS infections made up only 0.6% of the cases in our study. According to our study, stroke, movement disorders, CNS neoplasm, hypertensive and metabolic encephalopathies, delirium, subarachnoid hemorrhage, and motor neuron dis- eases were more common in patients over 60 years old. In patients under 60 years old, epilepsy, benign paroxysmal positional vertigo (BPPV ), headache disorders, demyelinat- ing disorders, Cerebral venous thrombosis (CVT), CNS infec- tions, and psychogenic disorders were the most common dis- eases. Our study also showed that the most common neu- rological findings in patients evaluated due to conscious- ness impairment were ischemic stroke, hemorrhagic stroke, epilepsy, metabolic encephalopathy, cerebral venous throm- bosis, delirium, and drug intoxication. These groups of pa- tients usually receive consultations from the neurology de- partment in the ED. This is almost similar to a study by Ufuk Emre and his colleagues, which demonstrated that is- chemic stroke, hemorrhagic stroke, hypoxic and metabolic encephalopathy were the most common neurologic diag- noses in patients evaluated due to consciousness impair- ment (11). 5. Limitation Even though our sample was modest, we only investigated patients admitted to the ED of our hospital. Patients in the outpatient clinic were not included in this study; therefore, the neurological disease pattern in outpatient was not stud- ied here. Another limitation is the absence of assessment of the outcome and related factors, the short duration of the study, and the fact that it is a single-center cross-sectional study that does not necessarily cover the country’s epidemi- ology. To avoid bias in patient selection, a team of expert physicians, including emergency, neurology, and radiology physicians, did collaborative work to ensure correct patient selection and proper diagnosis. Multi-center studies, includ- ing outpatient neurological disease patterns and outcomes, as well as other study designs should be considered. One ma- jor strength of this study is it provides an overview assess- ment of common neurological emergencies in the country (which was missing data), which is why we consider it to be a valuable study. 6. Conclusions In our study, neurological emergencies accounted for 3.7% of all emergency admissions. Stroke, epileptic seizures, cerebral venous thrombosis, encephalopathies, and acute spinal cord diseases were the most common neurological disorders. The admission rate was very high following neurological assess- ment by neurologists. 7. Declarations 7.1. Acknowledgments We thank all the medical team members at the departments of emergency medicine and neurology of our hospital, in- cluding doctors, nurses, the health care experts, and other staff for their assistance in conducting this research. We also thank the patients and their families for their cooperation. In addition, we thank the education and research section of the hospital for their support and encouragement through- out the process of this study. 7.2. Conflict of interest The authors declare no conflict of interest 7.3. Fundings and supports We did not receive any funding to perform this study. This was completely voluntary research work conducted by the authors of this research paper. 7.4. Authors’ contribution All authors made a significant contribution to the work re- ported, whether that is in the conception, study design, ex- ecution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work. 7.5. Data Sharing Statement The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable This open-access article distributed under the terms of the Creative Commons Attribution NonCommercial 3.0 License (CC BY-NC 3.0). Downloaded from: https://journals.sbmu.ac.ir/aaem/index.php/AAEM/index M. Sheikh Hassan et al. 6 request. 7.6. Ethical approval This study was performed in line with the principles of the Declaration of Helsinki. The study was reviewed and ac- cepted by the ethics committee of Mogadishu Somali Turk- ish Training and Research Hospital (Ethics Protocol No: MSTH/7128, Decision No: 410). All patients/caregivers were informed about the purpose of this study. Written informed consent was obtained from the patient/relatives during data collection and they signed the consent form. We declare that we have followed the protocols of our work center. Patients’ data confidentiality was respected. References 1. Kottapally M, Josephson SA. Common neurologic emer- gencies for nonneurologists: When minutes count. Cleve Clin J Med. 2016;83(2):116-26. 2. Olazarán J, Navarro E, Galiano M, Vaquero A, Guillem A, Villaverde F, et al. [Quality of neurological care in the emergency services: a study from the community- hospital]. Neurologia. 2009;24(4):249-54. 3. McMullan JT, Knight WA, Clark JF, Beyette FR, Panci- oli A. Time-critical neurological emergencies: the unful- filled role for point-of-care testing. International Journal of Emergency Medicine. 2010;3(2):127-31. 4. Moulin T, Sablot D, Vidry E, Belahsen F, Berger E, Lemounaud P, et al. Impact of Emergency Room Neurol- ogists on Patient Management and Outcome. European Neurology. 2003;50(4):207-14. 5. Mondal BA, Chowdhury RN, Rahman KM, Khan SU, Hasan A, Hoque MA, et al. Major co-morbidities in stroke patients: a hospital based study in Bangladesh. Journal of Dhaka Medical College. 2012;21(1):16-22. 6. Solomon G. Pattern of Neurologic Emergencies in Tikur Anbessa Specialized Hospital. Addis Ababa, Ethiopia. 2014. 7. Warlow C, Humphrey P, Venables G. UK neurologists and the care of adults with acute neurological problems. Clin- ical Medicine. 2002;2(5):436. 8. Piecuch JF, Lieblich SE. Neurologic emergencies. Dent Clin North Am. 1995;39(3):567-75. 9. Moeller JJ, Kurniawan J, Gubitz GJ, Ross JA, Bhan V. Diag- nostic Accuracy of Neurological Problems in the Emer- gency Department. Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques. 2008;35(3):335-41. 10. Craig J, Chua R, Russell C, Wootton R, Chant D, Patter- son V. A cohort study of early neurological consultation by telemedicine on the care of neurological inpatients. Journal of Neurology, Neurosurgery &amp; Psychi- atry. 2004;75(7):1031. 11. Emre U, Demir AS, Acıman E, Çabuk N, Kıran S, Ünal A. The Profile of Neurology Patients Evaluated in the Emergency Department. Turkish Journal of Neurology. 2009;15(3):134-9. 12. Lange M, Braatz V, Tomiyoshi C, Nóvak F, Fernandes A, Zamproni L, et al. Neurological diagnoses in the emer- gency room: Differences between younger and older pa- tients. Arquivos de neuro-psiquiatria. 2011;69:212-6. 13. Saddichha S, Saxena MK, Vibha P, Methuku M. Neu- rological Emergencies in India – Lessons Learnt and Strategies to Improve Outcomes. Neuroepidemiology. 2009;33(3):280-5. 14. Carroll C, Zajicek J. Provision of 24 hour acute neurology care by neurologists: manpower requirements in the UK. Journal of Neurology, Neurosurgery &amp; Psychi- atry. 2004;75(3):406. 15. Vural S, Hamamci M, Kilic N. Analysis of the neurol- ogy consultations in the emergency department and diagnostic accuracy of emergency physicians for the neurologic emergencies. Annals of Medical Research. 2021;27(6):1797-802. 16. Geja E, Tadesse F, Deribe B. Neurologic Emergency Out- come and Associated Factors in a Hawassa University Comprehensive Specialized Hospital, Ethiopia. J Neurol Disord. 2019;7(401):2. 17. Chowdhury RN, Hasan ATMH, Rahman YU, Khan SI, Hussain AR, Ahsan S. Pattern of neurological disease seen among patients admitted in tertiary care hospital. BMC Research Notes. 2014;7(1):202. 18. Vural S, Ramadan H. A short review on the comparison of consultation systems and tools in the emergency de- partment practice: Tele-consultation. Cumhuriyet Medi- cal Journal. 2019;41(2):239-43. 19. Owolabi LF, Shehu MY, Shehu MN, Fadare J. Pattern of neurological admissions in the tropics: Experience at Kano, Northwestern Nigeria. Annals of Indian Academy of Neurology. 2010;13(3):167. 20. Mapoure YN, Ongono JS, Nkouonlack C, Beyiha G, Mouelle AS, Luma HN. Neurological disorders in the emergency centre of the Douala General Hospital, Cameroon: A cross-sectional study. African Journal of Emergency Medicine. 2015;5(4):165-70. This open-access article distributed under the terms of the Creative Commons Attribution NonCommercial 3.0 License (CC BY-NC 3.0). Downloaded from: https://journals.sbmu.ac.ir/aaem/index.php/AAEM/index Introduction Methods Results Discussion Limitation Conclusions Declarations References