Background The shortage of neurologists in rural areas limits patient access, making it hard for those with neurological conditions to receive timely care. Long travel distances are a barrier, often resulting in worsened health outcomes. The review aims to assess the current landscape of tele-neurology, examining existing services, evaluating patient outcomes, and identifying challenges and legal concerns. Methods This review brings together insights from multiple studies and programs, with a particular focus on initiatives like the clinical video tele-health (CVT) system created by the Veterans Health Administration, allowing neurologists to deliver direct care to veterans. We also look into the web-based tele-stroke program established by the University of South Carolina, enabling neurologists to oversee acute ischemic stroke patients in rural Emergency Departments in collaboration with local ED physicians. Additionally, we explore global partnerships in telemedicine that are being tailored for tele-neurology. Results Tele-neurology has demonstrated significant potential in delivering quality neurological care, resulting in high patient satisfaction and notable time and cost savings. The TRUST-tPA trial established a tele-stroke network connecting ten community hospital emergency rooms to a centralized stroke center, effectively serving patients unable to reach stroke units within the critical 4.5-hour window.