Pediatric neurological emergencies are a significant concern, often leading to high rates of admission to pediatric intensive care units and increased mortality rates. In Saudi Arabia, the emergency department (ED) is the main entry point for most patients in the healthcare system. This study aimed to provide a comprehensive overview of pediatric neurology visits to the ED, analyzing patient demographics, clinical presentations, and outcomes. The retrospective study was conducted at a large tertiary care center and examined 960 pediatric patients with neurological emergencies out of 24,088 pediatric ED visits. The study population consisted mainly of male participants (56.5%) and 43.5% female participants, with a mean age of 5.29 ± 4.19 years. School-age children (6–12 years) represented the largest population group (29.1%), and over a third of patients were triaged as ‘resuscitation’ (n = 332, 34.6%). Seizures (n = 317, 33.0%) and postictal states (n = 187, 19.5%) were the most common reasons for seeking emergency care, accounting for over half of all cases. There were statistically significant differences in provisional diagnosis and chief complaints across different age groups (P >0.001 and P <0.001, respectively). The most common outcome was discharge (n = 558; 58.1%), and the mean length of stay was 10.56 ± 20.33 hours. Neuro-emergencies in pediatrics are a concern and a leading cause of mortality, morbidities, and increased hospital visits. The observed variations in presentation and outcomes across age groups further emphasize the importance of tailored approaches.