Extending telestroke to broader teleneurology in sparsely populated regions: real-world experience from a German network

Introduction Telestroke networks provide established infrastructure for specialist neurological care in rural regions, but their real-world use beyond stroke remains insufficiently characterized. We aimed to describe the diagnostic spectrum of acute teleconsultations within a comprehensive teleneurology network in sparsely populated and structurally underserved regions of Northeast Germany and to explore factors associated with the distribution of diagnoses. Methods We conducted a retrospective observational analysis of acute teleneurological consultations performed within the ANNOTeM network at 12 continuously participating hospitals between January 2023 and December 2024. Consultations were classified into seven predefined diagnostic categories. Diagnostic distribution was analyzed descriptively; univariable binary and exploratory multinomial logistic regression models were used to examine associations with patient-, hospital-, and regional-level characteristics. Results Of 4,697 consultations, 4,207 had a single diagnostic category. Suspected stroke accounted for 60.0%, whereas 40.0% concerned non-stroke presentations, reaching 48.3% at individual hospitals (range 30.8–48.3%). More than 70% of non-stroke cases received another neurological diagnosis rather than a non-neurological diagnosis. Median patient age was 70 years. Increasing age was significantly associated with neurological diagnosis (OR per 10 years 1.09, 95% CI 1.04–1.15; p < 0.001) and suspected stroke (OR 1.42, 95% CI 1.38–1.48; p < 0.001). A higher regional proportion of residents aged 60–80 years was significantly associated with neurological diagnosis (OR 1.04, 95% CI 1.00–1.07; p = 0.039). A higher density of neurology-related outpatient specialists was significantly associated with a lower relative likelihood of another neurological diagnosis compared with suspected stroke (OR 0.94, 95% CI 0.89–0.98; p = 0.008). Discussion Overall, these findings demonstrate that our network, built on an established telestroke infrastructure, is frequently used for comprehensive acute teleneurology in routine clinical care. The substantial non-stroke workload, consisting mostly of neurological diagnoses, together with its associations with demographic structure and specialist availability, highlights the growing relevance of comprehensive teleneurology in aging and underserved regions. Existing telestroke networks may therefore provide a practical platform for bridging geographical and temporal gaps in neurological specialist care beyond stroke.