Objective: To determine the current state of urgent neurologic in-hospital consultations, this study investigated urgent neurologic in-hospital consultations in a large tertiary hospital in China over a 4-year period. Methods: We conducted a retrospective study of urgent neurologic in-hospital consultations in a large tertiary hospital for 4 consecutive years (Jan. 1, 2014 to Dec. 31, 2017). The clinical data of patients who received urgent neurologic in-hospital consultations were obtained from the electronic medical record system and analyzed. Results: A total of 1437 cases (age range: 9–103 years old; average age: 60.3; males: 54.6%) were included in the study; 57.5% of the consultations were in line with urgent consultation criteria. The departments applying for urgent consultation involved 29Twenty-nine clinical departments were involved in the urgent consultations. consciousness disorder (36.0%), tics/stiffness (13.6%), limb weakness (8%), and mental disorders (5.6%). Urgent consultation diseases were divided into three categories: neurological diseases (77.8%), non-neurological non-neurological diseases (10.4%), and undiagnosed diseases (11.8%). The common neurological disorders included urgent cerebrovascular disease (33.6%), epilepsy/status epilepticus (15.8%), and metabolic or infective toxic encephalopathy (14.9%). Conclusions: Most urgent neurologic consultation is in line with consultations followed the guidelines for urgent neurologic consultation criteria. Non-neurologic. Non-neurological physicians in clinics should enrich their knowledge of frequently occurring urgent and critical neurological diseases.