A significant expansion of acute neurological services in the UK is planned, but there is little contemporary information on the burden of acute neurology in modern hospital practice. The objective of this study was to provide comprehensive information on the numbers of patients admitted with acute neurological problems, referral patterns to neurological services, and the utilisation of resources for investigation of neurological problems. The method used was a prospective survey of 1,197 acute medical admissions to a district general hospital in North-West England. It was found that neurological problems accounted for 181 (15·1%) of acute admissions. Of these, only 59 (32·6%) saw a neurologist or neurosurgeon, and only 28 (15·5%) were admitted under the neurological services. The most common presenting complaints were cerebrovascular disease (34·3%), seizures (26·5%), and headache (17·7%). One hundred and nine patients (9·1%) underwent cranial CT scanning, 68 within 48 hours of admission. It was concluded that acute neurological problems are common. In many centres, even those with embedded neurological services, they are still largely managed by general physicians. A restricted range of neurological conditions make up most of the acute case load. These facts should be taken into consideration when planning acute neurological services, and also in the delivery of undergraduate and postgraduate education in neurology.
