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Introduction Headache is a frequent cause of consultation; it is important to detect patients with secondary headache, particularly high-risk secondary headache. Such systems as the Manchester Triage System (MTS) are used for this purpose. This study aims to evaluate the frequency of sub-triage in patients attending the Emergency Department due to headache. Material and methods We studied a series of consecutive patients who came to the Emergency Department with headache and presenting some warning sign, defined as the presence of signs leading the physician to request an emergency neuroimaging study and/or assessment by the on-call neurologist. The reference diagnosis was established by neurologists. We evaluated the MTS triage level assigned and the presence of warning signs that may imply a higher level than that assigned. Results We registered a total of 1,120 emergency department visits due to headache, and 248 patients (22.8%) were eligible for study inclusion. Secondary headache was diagnosed in 126 cases (50.8% of the sample; 11.2% of the total), with 60 cases presenting high-risk secondary headache (24.2%; 5.4%). According to the MTS, two patients were classified as immediate (0.8%), 26 as very urgent (10.5%), 147 as urgent (59.3%), 68 as normal (27.4%), and five as not urgent (2%). The percentage of patients under-triaged was 85.1% in the very urgent classification level and 23.3% in the urgent level. Conclusion During the study period, at least one in 10 patients attending the Emergency Department due to headache had secondary headache; one in 20 had high-risk secondary headache. The MTS under-triaged most patients with warning signs suggesting a potential emergency.

We describea series of patients with COVID-19 who presented with seizures, reported in the Spanish Society of Neurology's COVID-19 Registry. This observational, descriptive,multicentre, registry-based study includes patients with confirmed COVID-19 who experienced seizures during active infection.Wedescribe theclinicalpresentation of COVID-19,seizures,and resultsof complementary tests.Wealsodescribe the suspectedaetiologyof the seizures. Of 232 reported cases, 26 (11.2%) presented with seizures;7 of these patients (26.9%) had prior history of epilepsy, whereas the remaining 19 (73.1%) had no history of seizures.In most cases, seizures presented on days 0 and 7 after onset of COVID-19. By seizure type, 8 patients (30.7%) presentedgeneralised tonic-clonic seizures, 7 (26.9%) status epilepticus, 8 (30.7%) focal impaired-awareness seizures, and 4 (11.7%) secondary generalised seizures.Six patients (23.1%) also presented other neurological symptoms, includingaltered mental status and decreased level of consciousness. Predisposing factors for seizures (eg, dementia, tumour, cerebrovascular disease) were observed in 10 of the 19 patients with no prior history of epilepsy (52.6%). Patients with COVID-19 may present with seizures over the course of the disease,either alone or in the context of encephalopathy.Seizures may present in patients with no prior history of epilepsy; however, most of these patients present predisposing factors.

Resumen Objetivos El dolor orofacial y cervical es un motivo de consulta frecuente, y puede deberse a multiples procesos patologicos. Entre ellos se encuentra el sindrome de Eagle, entidad muy infrecuente cuyo origen se atribuye a una osificacion del ligamento estilohioideo o una elongacion de la apofisis estiloides. Presentamos una serie de cinco pacientes con dicho diagnostico. Material y metodos Se describen las caracteristicas demograficas y clinicas de cinco pacientes atendidos en la Unidad de Cefaleas de dos hospitales terciarios por un cuadro compatible con sindrome de Eagle, y su respuesta a distintos tratamientos. Resultados Se trata de tres varones y dos mujeres de entre 24 y 51 anos, con dolor de localizacion predominante en un oido y la region amigdalina ipsilateral, de cualidad sorda y de gran intensidad. En todos ellos el patron temporal era cronico y continuo, con exacerbaciones desencadenadas por la deglucion. Cuatro pacientes habian realizado multiples consultas en servicios de otorrinolaringologia, y uno de ellos habia recibido tratamiento antibiotico ante la sospecha de tubaritis. En todos los casos la palpacion de la fosa amigdalina resulto dolorosa. En tres de los pacientes se demostro elongacion de la apofisis estiloides y/o calcificacion del ligamento estilohioideo mediante tomografia computarizada. Cuatro mejoraron con tratamiento neuromodulador (duloxetina, gabapentina, pregabalina) y solo uno preciso cirugia con escision de la apofisis estiloides. Conclusiones El sindrome de Eagle es una causa de dolor craneofacial poco frecuente y posiblemente infradiagnosticada. Aportamos cinco nuevos casos que permiten delimitar tanto la semiologia como los posibles tratamientos.

Resumen: Introducción: La epilepsia es una enfermedad prevalente en países en vías de desarrollo debido al mayor número de causas que pueden producirla, al menos duplicándose tanto incidencia como prevalencia en comparación con nuestro medio. Además, existe una gran estigmatización y los medios para su manejo son limitados. Material y métodos: Estudio observacional descriptivo mediante la realización de un cuestionario a profesionales sanitarios de 3 hospitales de Camerún, interrogando sobre factores relacionados con el manejo de la epilepsia, en diciembre de 2016. Se presentan los datos como media o porcentaje. Resultados: Participaron 38 profesionales sanitarios, de los cuales el 42,1% eran mujeres, con una edad media de 40,1 años (rango 22-62). Respecto a la causa de la enfermedad un 68,4% la considera psiquiátrica, 34,2% degenerativa, 28,9% hereditaria y 21,1% secundaria a una infección. En cuanto al manejo un 23,7% consideraba suficiente la anamnesis para llegar al diagnóstico. Solo un 60,5% consideraba la historia importante en el diagnóstico, 52,6% consideraba necesario un EEG, un 28,9% creía importantes las pruebas de laboratorio y un 13,2% la neuroimagen. Durante el embarazo solo un 36,8% considera importante asociar ácido fólico, solo el 65,8% cree que hay que mantener el tratamiento y solo un 39,5% creía recomendable la lactancia. Acerca del conocimiento de antiepilépticos, el número medio de fármacos conocido era de 2, siendo el más conocido el fenobarbital (81,6%) seguido de carbamacepina (55,3%) y ácido valproico (28,9%). Conclusiones: La educación y la mejor información sobre la enfermedad, su diagnóstico y las opciones de manejo son necesarias en los profesionales sanitarios para optimizar el manejo y con ello la calidad de vida de los pacientes. Abstract: Introduction: Epilepsy is especially prevalent in developing countries: incidence and prevalence rates are at least twice as high as in our setting. Epilepsy is also highly stigmatised, and few resources are available for its management. Material and methods: We performed a descriptive observational study in December 2016, distributing a questionnaire on epilepsy management to healthcare professionals from 3 different hospitals in Cameroon. Data are presented as means or percentages. Results: Thirty-eight healthcare providers participated in the survey; 42.1% were female and mean age was 40.1 years (range, 22-62). Regarding the causes of epilepsy, 68.4% considered it a psychiatric condition, 34.2% a degenerative disease, 28.9% a hereditary condition, and 21.1% secondary to infection. In terms of management, 23.7% considered that thorough clinical history is sufficient to establish a diagnosis. Only 60.5% considered the clinical interview to be important for diagnosis, 52.6% considered EEG to be necessary, and 28.9% considered laboratory analyses to be important. Only 13.2% mentioned neuroimaging. In the treatment of pregnant women, 36.8% recommended folic acid supplementation, 65.8% believed antiepileptic treatment should be maintained, and only 39.5% recommended breastfeeding. Concerning treatment, the participants knew a mean of 2 antiepileptic drugs: phenobarbital was the best known (81.6%), followed by carbamazepine (55.3%) and valproic acid (28.9%). Conclusions: There is a need among healthcare professionals for education and information on the disease, its diagnosis, and management options, in order to optimise management and consequently improve patients’ quality of life.

Introduction: When a patient is diagnosed with primary headache or craniofacial neuralgia in the emergency department or in primary care, and is referred to a neurologist due to the complexity of the case, it is useful to know whether additional examination should be sought and the priority (urgent, preferential, or normal) with which the patient should be seen. This will avoid unnecessary delays in patients with disabling headache and where organic causes are suspected.In order to issue recommendations on this matter, the Spanish Society of Neurology's Headache Study Group has decided to create a series of agreed recommendations constituting a referral protocol for patients with headache and/or craniofacial neuralgia. Development: Young neurologists with an interest and experience in headache were invited to draft a series of practical guidelines in collaboration with the Spanish Society of Neurology's Headache Study Group Executive Committee. For practical reasons, the document was divided into 2 articles: this first article focuses on primary headaches and craniofacial neuralgias and the second on secondary headaches. In order for the recommendations to be helpful for daily practice they follow a practical approach, with tables summarising referral criteria, examinations to be performed, and referral to other specialists. Conclusions: We hope to offer a guide and tools to improve decision-making regarding patients with headache, identifying complementary tests to prioritise and referral pathways to be followed, in order to avoid duplicated consultations and delayed diagnosis and treatment. Resumen: Introducción: Cuando tras una correcta anamnesis y exploración neurológica se diagnostica a un paciente con una cefalea primaria o una neuralgia craneofacial en urgencias o atención primaria y se decide derivar a neurología por complejidad es útil conocer si además se deberían solicitar exploraciones complementarias y la preferencia (urgente, preferente o normal) con la que se debería derivar para que el paciente llegue a la consulta del neurólogo sin demoras innecesarias en pacientes con dolores incapacitantes o con sospecha de organicidad.Por este motivo, el Grupo de Estudio de Cefalea de la Sociedad Española de Neurología, ha decidido crear unas recomendaciones consensuadas que establezcan un protocolo de derivación de pacientes con cefalea y/o neuralgias craneofaciales. Desarrollo: Se ha contactado con neurólogos jóvenes con interés y experiencia en cefalea y con la Junta Directiva del Grupo de Estudio de Cefalea de la Sociedad Española de Neurología que han desarrollado este documento que, por razones prácticas, se ha dividido en 2 artículos. Esta primera centrada en las cefaleas o neuralgias craneofaciales primarias y una segunda que se focaliza en las cefaleas secundarias. El enfoque es práctico con tablas que resumen los criterios de derivación con exploraciones complementarias y otros especialistas a los que derivar, para que sea útil y facilite su uso en nuestra práctica asistencial diaria. Conclusiones: Esperamos ofrecer una guía y herramientas para mejorar la toma de decisiones ante un paciente con cefalea, valorando exploraciones a priorizar y qué circuitos seguir para así evitar la duplicación de consultas y retrasos en el diagnóstico y en el tratamiento.

Resumen Introduccion La pandemia COVID-19 ha provocado un inusitado impulso a la telemedicina (TM). Analizamos el impacto de la pandemia en la TM aplicada en las consultas de cefaleas espanolas, revisamos la literatura y lanzamos unas recomendaciones para implantar la TM en las consultas. Metodo Tres fases: 1) Revision de la base Medline desde el ano 1958 (primera experiencia de TM); 2) Formulario Google Forms enviado a todos los neurologos del Grupo de Estudio de Cefaleas de la Sociedad Espanola de Neurologia (GECSEN), y 3) Consenso on-line de expertos GECSEN para emitir recomendaciones para implantar la TM en Espana. Resultados La pandemia por COVID-19 ha empeorado los tiempos de espera presenciales, incrementando el uso de todas las modalidades de TM antes y despues de abril de 2020: telefono fijo (del 75% al 97%), telefono movil (del 9% al 27%), correo electronico (del 30% al 36%) y videoconsulta (del 3% al 21%). Los neurologos son conscientes de la necesidad de ampliar la oferta con videoconsultas, claramente in crescendo, y otras herramientas de e-health y m-health. Conclusiones Desde el GECSEN recomendamos y animamos a todos los neurologos que asisten a pacientes con cefaleas a implantar recursos de TM, teniendo como objetivo optimo la videoconsulta en menores de 60-65 anos y la llamada telefonica en mayores, si bien cada caso debe individualizarse. Se debera contar previamente con la aprobacion y asesoramiento de los servicios juridicos e informaticos y de la direccion del centro. La mayoria de los pacientes con cefalea y/o neuralgia estable son candidatos a seguimiento mediante TM, tras una primera visita que tiene que ser siempre presencial.

Encephalopathy is a common complication of COVID-19 that can both be a challenge to manage and also negatively impacts prognosis. Whilst encephalopathy may be due to common systemic causes, such as hypoxia, COVID-19 has also been associated with more prolonged encephalopathy due to less common but nevertheless severe complications, such as inflammation of the brain parenchyma, cerebrovascular involvement and seizures, which may be disproportionate to COVID-19 severity and which require specific management. The aim of this review is to provide pragmatic guidance on the management of COVID-19 encephalopathy through a consensus agreement of the Global COVID-19 Neuro-Research Coalition. A systematic literature search of Medline, MedRxiv, and BioRx was conducted between 1st January 2020 and 11th June 2021 with additional review of references cited within the identified bibliographies. A modified Delphi-approach was then undertaken to develop recommendations along with a parallel approach to score the strength of both the recommendation and the supporting evidence. This manuscript presents analysis of contemporaneous evidence for definition, epidemiology, and pathophysiology of COVID-19 encephalopathy and practical guidance for clinical assessment, investigation, and acute and long-term management.

[Background] Anosmia is common in Coronavirus disease 2019, but its impact on prognosis is unknown. We analysed whether anosmia predicts in-hospital mortality; and if patients with anosmia have a different clinical presentation, inflammatory response, or disease severity., [Methods] Retrospective cohort study including all consecutive hospitalized patients with confirmed Covid-19 from March 8th to April 11th, 2020. We determined all-cause mortality and need of intensive care unit (ICU) admission. We registered the first and worst laboratory parameters. Statistical analysis was done by multivariate logistic and linear regression., [Results] We included 576 patients, 43.3% female, and aged 67.2 years in mean. Anosmia was present in 146 (25.3%) patients. Patients with anosmia were more frequently females, younger and less disabled and had less frequently hypertension, diabetes, smoking habit, cardiac and neurological comorbidities. Anosmia was independently associated with lower mortality (OR: 0.180, 95% CI: 0.069–0.472) and ICU admission (OR: 0.438, 95% CI: 0.229–0.838, p = 0.013). In the multivariate analysis, patients with anosmia had a higher frequency of cough (OR: 1.96, 95%CI: 1.18–3.28), headache (OR: 2.58, 95% CI: 1.66–4.03), and myalgia (OR: 1.74, 95% CI: 1.12–2.71). They had higher adjusted values of hemoglobin (+0.87, 95% CI: 0.40–1.34), lymphocytes (+849.24, 95% CI: 157.45–1541.04), glomerular filtration rate (+6.42, 95% CI: 2.14–10.71), and lower D-dimer (−4886.52, 95% CI: −8655.29-(−1117.75)), and C-reactive protein (−24.92, 95% CI: −47.35-(−2.48))., [Conclusions] Hospitalized Covid-19 patients with anosmia had a lower adjusted mortality rate and less severe course of the disease. This could be related to a distinct clinical presentation and a different inflammatory response.

Introduction: Orofacial and cervical pain are a frequent reason for neurology consultations and may be due to multiple pathological processes. These include Eagle syndrome (ES), a very rare entity whose origin is attributed to calcification of the stylohyoid ligament or elongation of the temporal styloid process. We present a series of five patients diagnosed with ES. Methods: We describe the demographic and clinical characteristics and response to treatment of 5 patients who attended the headache units of 2 tertiary hospitals for symptoms compatible with Eagle syndrome. Results: The patients were 3 men and 2 women aged between 24 and 51, presenting dull, intense pain, predominantly in the inner ear and the ipsilateral tonsillar fossa. All patients had chronic, continuous pain in the temporal region, with exacerbations triggered by swallowing. Four patients had previously consulted several specialists at otorhinolaryngology departments; one had been prescribed antibiotics for suspected Eustachian tube inflammation. In all cases, the palpation of the tonsillar fossa was painful. Computed tomography scans revealed an elongation of the styloid process and/or calcification of the stylohyoid ligament in 3 patients. Four patients improved with neuromodulatory therapy (duloxetine, gabapentin, pregabalin) and only one required surgical excision of the styloid process. Conclusions: Eagle syndrome is a rare and possibly underdiagnosed cause of craniofacial pain. We present 5 new cases that exemplify both the symptoms and the potential treatments of this entity. Resumen: Objetivos: El dolor orofacial y cervical es un motivo de consulta frecuente, que puede deberse a múltiples procesos patológicos. Entre ellos se encuentra el síndrome de Eagle, entidad muy infrecuente cuyo origen se atribuye a una osificación del ligamento estilohioideo o una elongación de la apófisis estiloides. Presentamos una serie de cinco pacientes con dicho diagnóstico. Material y métodos: Se describen las características demográficas y clínicas de cinco pacientes atendidos en las Unidad de Cefaleas de dos hospitales terciarios por un cuadro compatible con síndrome de Eagle, y su respuesta a distintos tratamientos. Resultados: Se trata de 3 varones y 2 mujeres, de entre 24 y 51 años, con dolor de localización predominante en un oído y la región amigdalina ipsilateral, de cualidad sorda y de gran intensidad. En todos ellos el patrón temporal era crónico y continuo, con exacerbaciones desencadenadas por la deglución. Cuatro pacientes habían realizado múltiples consultas en servicios de otorrinolaringología, y uno de ellos había recibido tratamiento antibiótico ante la sospecha de tubaritis. En todos los casos la palpación de la fosa amigdalina resultó dolorosa. En tres de los pacientes se demostró elongación de la apófisis estiloides y/o calcificación del ligamento estilohioideo mediante tomografía computarizada. Cuatro mejoraron con tratamiento neuromodulador (duloxetina, gabapentina, pregabalina) y sólo uno precisó cirugía con escisión de la apófisis estiloides. Conclusiones: El síndrome de Eagle es una causa de dolor cráneo-facial poco frecuente, y posiblemente infradiagnosticada. Aportamos cinco nuevos casos que permiten delimitar tanto la semiología como los posibles tratamientos.

Introduction: Coronavirus disease 2019 (Covid-19) might present neurologic symptoms. We aimed to evaluate the frequency and type of neurologic symptoms in patients with Covid-19 at the moment of emergency department (ED) visit, and their impact in the prognosis. Methods: Retrospective cohort study including all consecutive confirmed Covid-19 cases that were hospitalized between March 8th and April 11th, 2020. We compared, in patients with and without neurological symptoms on admission, demographic, clinical presentation, and frequency and type of abnormal laboratory values. We analyzed the variables that were associated with in-hospital all-cause mortality by Cox-regression log rank test. Results: We included 576 patients, 250 (43·3%) female, aged 67·2 years in mean. At the moment of ED visit, 320 (55·6%) patients described neurologic symptoms, including anosmia in 146 (25·3%), myalgia in 139 (24·1%), headache in 137 (23·8%) and altered mental status in 98 (17·0%). In those patients, neurologic symptoms started the first day of symptoms in 198 (54·2%) cases. Patients with neurologic symptoms presented later to the ED (7·9 vs. 6·6 days, p=0·019). In patients with neurologic symptoms, only four (0·6%) cases had not typical Covid-19 general symptoms and only six (1·9%) had a normal laboratory results at the moment of ED presentation, for a sensitivity of 98·7% (95% confidence interval (CI): 96·6-99·6%) and 98·1% (95% CI: 95·7-99·2%), respectively. In the multivariate Cox-regression analysis of mortality predictors, anosmia (HR: 0·358, 95%CI: 0·140-0·916) and altered mental status (HR: 1·867, 95%CI: 1·162-3·001) remained statistically significant. Conclusion: Neurologic symptoms were the most frequent extrapulmonary symptoms. They were present in half of the patients with Covid-19 at the time of the ED visit. In almost all of the cases, typical Covid-19 general symptoms and/or laboratory abnormalities were present. The presence of neurologic symptoms at the moment of ED presentation was an independent predictor of mortality. Funding Statement: The present study did not have any specific source of funding. Declaration of Interests: Authors declare not to have any conflict of interest. Ethics Approval Statement: The study was approved by the local ethics review board (PI-20-1751), which waived the need of written informed consent.

Background: Vaccine induced immune medicated thrombocytopenia or VITT, is a recent and rare phenomenon of thrombosis with thrombocytopenia, frequently including cerebral venous thromboses (CVT), that has been described following vaccination with adenovirus vaccines ChAdOx1 nCOV-19 (AstraZeneca) and Ad26.COV2.S Johnson and Johnson (Janssen/J&J). The evaluation and management of suspected cases of CVT post COVID-19 vaccination are critical skills for a broad range of healthcare providers. Methods: A collaborative comprehensive review of literature was conducted among a global group of expert neurologists and hematologists. Findings: Strategies for rapid evaluation and treatment of the CVT in the context of possible VITT exist, including inflammatory marker measurements, PF4 assays, and non-heparin anticoagulation. Interpretation: There are many unanswered questions regarding cases of CVT, possibly in association with VITT. Public health specialists should explore ways to enhance public and professional education, surveillance, and reporting of this syndrome to reduce its impact on health and global vaccination efforts. Funding: None

Objective We report the findings from the Spanish Society of Neurology's NeuroCOVID-19 Registry. Methods We performed a multicentre study of patients with neurological manifestations of COVID-19. Participating physicians reported demographic, clinical, and paraclinical data and judged the involvement of COVID-19 in causing neurological symptoms. Results A total of 233 cases were submitted, including 74 different combinations of manifestations. The most frequently reported were stroke (27%), neuromuscular symptoms (23.6%), altered mental status (23.6%), anosmia (17.6%), headache (12.9%), and seizures (11.6%). The mean age of patients was 61.1 years, with 42.1% being women; a higher proportion of women was recorded among patients with altered mental status, anosmia, and headache. The onset of symptoms differed within categories. Onset of anosmia occurred a mean (standard deviation) of 2.9 (2.5) days after the first general symptom, whereas neuromuscular symptoms appeared after 13.9 (10.1) days. Neurological symptoms were persistent in 33% of patients. General symptoms were present in 97.7% of patients, and results from general laboratory studies were abnormal in 99.4% of patients. Cerebrospinal fluid analysis findings were abnormal in 62.7% of the cases in which this test was performed (n = 51), but positive results for SARS-CoV-2 were only found in one case. Conclusions The neurological manifestations of COVID-19 are diverse. Anosmia, myalgia, and headache occur earlier in the course of the disease. Altered mental status, neuromuscular symptoms, and stroke are associated with greater severity. COVID-19 must be incorporated into most clinical and radiological differential diagnoses. COVID-19 may cause persistent and disabling neurological symptoms., Highlights • NeuroCovid-19 is polymorph: Authors reported >70 different combinations of neurological syndromic presentations. • The timing of the neurological symptoms differ: from the early onset (anosmia, headache, myalgia) to later stages (altered mental status, seizures, stroke, neuromuscular symptoms). • Some neurological symptoms might persist, as headache or anosmia; while other may cause persistent disability, as stroke or polyneuropathies. • Cerebrospinal fluid was frequently abnormal but direct isolation of SARS-CoV-2 occurred only in 1/233 cases. • Neurologists must be prepared to face the various neurological syndromes that may be associated with Covid-19 infection.

Objectives (i) To analyze if general cognitive performance, perceived health and depression are predictors of Subjective Memory Complaints (SMC) contrasting their effect sizes; (ii) to analyze the relationship between SMC and objective memory by comparing a test that measures memory in daily life and a classical test of associated pairs; (iii) to examine if different subgroups, formed according to the MFE score, might have different behaviors regarding the studied variables. Methods Sample: 3921 community-dwelling people (mean age 70.41 ± 4.70) without cognitive impairment. Consecutive non-probabilistic recruitment. Assessment: Mini Cognitive Exam (MCE), daily memory Rivermead Behavioural Memory Test (RBMT), Paired Associates Learning (PAL), Geriatric Depression Scale (GDS), Nottingham Health Profile (NHP). Dependent variable: Memory Failures Everyday Questionnaire (MFE). Results Two different dimensions to explain SMC were found: One subjective (MFE, GDS, NHP) and other objective (RBMT, PAL, MCE), the first more strongly associated with SMC. SMC predictors were NHP, GDS, RBMT and PAL, in this order according to effect size. Considering MFE scores we subdivided the sample into three groups (low, medium, higher scores): low MFE group was associated with GDS; medium, with GDS, NPH and RBMT, and higher, with age as well. Effect size for every variable tended to grow as the MFE score was higher. Conclusion SMC were associated with both health profile and depressive symptoms and, in a lesser degree, with memory and overall cognitive performance. In people with fewer SMC, these are only associated with depressive symptomatology. More SMC are associated with depression, poor health perception and lower memory.

Introduction: A new model permitting free choice of hospital has been introduced in the Region of Madrid. This may result in changes in how outpatient neurological care is provided and managed. The purpose of this study is to analyse initial visits to a general neurology department in the Region of Madrid and record the health district corresponding to each patient's residence. Methods: Observational and prospective study of a cohort of patients making initial outpatient visits to a neurology department between 16 September 2013 and 16 January 2014. Results: The study included 1109 patients (63.8% women, mean age 55.2 ± 20.5). The most frequent diagnostic groups were periodic headache, cognitive disorders, and neuromuscular diseases. Non-neurological diseases were diagnosed in 1.1% of the cases. The mean time of delay was 7.2 ± 5.1 days. Residents within the hospital's health district made up 73.8% of the total, while 26.2% chose a hospital outside of the health district corresponding to their residences. In the latter group, 59.5% made the choice based on the level of care offered, while 39.7% changed hospitals due to shorter times to consultation. The patients who came from another health district were younger (50.7 vs. 57.3, P