Neonatal encephalopathy (dummy foal syndrome) is the most common cause of neurological signs in neonatal foals. However, there are a wide variety of other causes that may be overlooked, including infections, traumatic, metabolic and congenital causes. There is much overlap between the clinical signs for many of these conditions, highlighting the need for thorough history taking, physical examination, laboratory testing and, in some cases, diagnostic imaging. In most cases, prompt treatment is required if there is to be any chance of survival, further highlighting the need for an accurate diagnosis. The prognosis of these conditions varies from rapidly correctable with appropriate treatment, to euthanasia being the only humane option.