Background: Neurological dysfunctions represent a large part of the activity in the pediatric intensive care unit (PICU). Non traumatic coma in children is a common cause of admission in pediatric emergency department and is reported to carry a high morbidity and mortality. The data from developing countries is limited.Objectives: To evaluate pattern of neurological dysfunction in critically ill patients admitted in PICU, in regards of prevalence, characteristics and outcome of these dysfunctions.Methods: A retrospective study includedpatients presented with neurological dysfunction, admitted in the PICU, Cairo University Pediatric Hospital, during the period from January 2011 to June 2012.Results:Out of 468 admitted, 139 patients (29.7 %), presented with neurological dysfunction. Out of the 139 patients, coma at presentation accounted for 82.7%, while neuromuscular diseases accounted for 17.3%. Central nervous system (CNS) infections were the highest cause of encephalopathy (28%), followed by septic encephalopathy (24%). Guillian-BarréSyndrome accounted for 79.2% of patients presented with neuromuscular diseases. Mortality accounted for 47.5% of all patients presented with neurological dysfunction representing 42.5 % of all PICU mortality. Coma accounted for 76% of mortality in patients studied. The only in depended risk factors for mortality were; Pediatric risk of mortality score III (PRISM III) (O.R.: 4.13), Glasgow coma score <8 (O.R.: 4.81) and hepatic insult (O.R.: 3.29). Prolonged length of stay> 19 days accounted for 26.8% of patients studied with high incidence in coma patients (73.4%). The only in depended risk factors for prolonged length of stay were need for mechanical ventilation (O.R.: 5.15) and septic shock (O.R.: 7.63).Conclusion: Infections were the leading cause of non-traumatic coma as well as the leading cause of mortality in our study. Low GCS, PRISM III score and hepatic insult were significantly associated with mortality in children presenting coma.