The question this study addressed. This study reports the differences in the spectrum, clinical presentation, and outcome of neurological conditions between an urban university hospital (Yaoundé) and a semi‑rural regional hospital (Bafoussam). What this study adds. This first direct urban–rural comparison in Cameroon shows that stroke is the leading pathology in both sites. However, traumatic brain injury is almost exclusive to Bafoussam (16.5%), while epilepsy and inflammatory CNS diseases are three times more frequent in Yaoundé. In‑hospital mortality is more than doubled in the rural setting (18.1% vs. 7.5%). This publication is available in full in Health Sciences and Disease.