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Introduction: Stroke is the second most common cause of death and major cause of disability worldwide. About a quarter of stroke patients are dead within a month, about a third by 6 months, and a half by 1 year. Although the most substantial advance in stroke has been the routine management of patients in stroke care units, intensive care unit has remained the choice for stroke patients’ care in developing countries. This study explores the mortality of stroke patients in intensive care unit setting in tertiary care neurological centre in a developing country.Methods: We collected data of stroke patients admitted in our ICU from August 2009 to Aug 2010 and analyzed.Results: Total 44 (10.25%) patients were admitted for acute stroke. Age ranged from 17-93 years. Low GCS (Glasgow Coma Scale), uncontrolled hypertension and aspiration pneumonia were common indications for admission in ICU. Total 23 (52.3%) patients had hemorrhagic stroke and 21(47.7%) patients had ischemic stroke. 13 (29.54%) patients of stroke died within 7 days, 9 (69.23%) patients of hemorrhagic stroke died within 6 days, and 4 patients (30.76%) of ischemic stroke died within 7 days. 6 (13.63%) patients left hospital against medical advice. All of these patients had ischemic stroke.Conclusions: Stroke mortality in intensive care unit remains high despite of care in tertiary neurological center in resource poor settings. Stroke care unit, which would also help dissemination of knowledge of stroke management, is an option for improved outcome in developing countriesKeywords: intensive care unit; mortality; stroke; stroke care unit.

Three cases of acute intermittent porphyria are reported. While in first case severe pain in abdomen with intermittent exacerbation was the only presentation, the second patient presented as accelerated hypertension and acute abdominal crises in whom the clinical course was characterized by development of deep coma due to inappropriate secretion of antidiuretic hormone before she made complete recovery. The third patient, initially manifested as acute encephalitic syndrome. After initial improvement, she developed features of acute intermittent porphyria i.e. acute abdomen, neuropsychiatric symptoms, and rapidly progressing acute motor neuropathy leading to respiratory and bulbar paralysis. In addition, she developed severe and fluctuating dysautonomia leading to cardiac arrest and fatal termination. The importance of early diagnosis, recognition of autonomic disturbances, prompt treatment and counseling for avoidance of precipitating factors is stressed. Kathmandu University Medical Journal | Vol.10 | No. 2 | Issue 38 | Apr – June 2012 | Page 96-99 DOI: http://dx.doi.org/10.3126/kumj.v10i2.7354