The pattern of neurological disorders (ND) is largely similar worldwide, but there are some significant differences in Africa. Central nervous system (CNS) infections are common presentations, and stroke and epilepsy are increasingly prevalent. However, age-related diseases such as dementia and Parkinson’s are less common, and multiple sclerosis is rare. Some neurological diseases, Konzo, tropical ataxic neuropathy and nodding syndrome are found only in Africa. Some of these differences lie in Africa’s distinct geographic, climate, social, economic and ethnic makeup. NDs in Africa are also changing over time, decreasing the frequency of the more traditional CNS infections, including acute bacterial meningitis, tetanus, cerebral malaria and sleeping sickness. This decrease has been replaced by the huge burden of HIV infection, where an estimated 26 million people live with HIV. At the same time, there has been an increase in the burden of non-communicable NDs in Africa, including stroke and dementia. Western lifestyle, increasing urbanization and life expectancy, now almost 62 years, play an increasing role in these disorders.