Background: Clinical spectrum of acute neurological disorders in children encompasses central nervous system (CNS) infections, stroke, intracranial space-occupying lesions, pseudotumor cerebri, and spinal cord disease. Presentations include altered consciousness, focal neurological deficits, fever and persistent vomiting. Neuroimaging frequently shows overlapping features, Objectives: To delineate the spectrum of acute neurological disorders in children and evaluate their correlation with imaging findings. Method: A prospective cross-sectional study was conducted over one-year among children aged 1 month to <18 years presenting with acute neurological conditions (<4 weeks duration). Cases with a prior diagnosis of cerebral palsy, seizure disorder, or febrile seizures were excluded. All participants underwent detailed clinical assessment, relevant laboratory investigations, and neuroimaging as indicated. Data were summarized as range, mean ± SD, frequencies, and relative frequencies. Categorical variables were compared using chi-square test, with a p-value <0.05 considered statistically significant. Statistical analysis was performed using SPSS version 21.0. Results: Of the 72 children included, 43 (59.7%) were male. The most commonly affected age group was 1–5 years (25%). CNS infections constituted 43%, intracranial space-occupying lesions (23.6%), stroke (11.1%), demyelinating disorders (8.3%), and neurometabolic disorders or intracranial hemorrhage (6.9%). Neuroimaging abnormalities were detected in 69.5% of patients, with clinical–radiological concordance observed in 50%. Conclusions: Acute neurological conditions demonstrated a prevalence of 1.7%, with the majority occurring in children under five years of age. Neuroimaging proved pivotal in early detection, characterization of disease processes, and assessment of potential complications.