Background Stroke in young person is less frequent than in older populations but has a major impact on the productive individuals and society. Objective To determining risk factors and etiological subtypes of cerebral infarctions in patients of young (20-49 years) age who were admitted to the First Central hospital in Ulaanbaatar, Mongolia. Methods This paper is based on a review of hospital-based studies of patients with cerebral infarction in age range 20-49 years which was conducted from 2009 to 2013. Data regarding onset of cerebral infarction, clinical manifestations, diagnostic test results of patients were examined during their hospital treatment and modified Rankin Scale scores at discharge. Subtyping of cerebral infarction was conducted in accordance with the Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria. Results Out of total number of 1289 patients admitted for cerebral infarctions, 259 (20.1%) were in the 20-49 year age range and the male-to-female ratio was 1.3:1. The most common conventional risk factors were hypertension (39.8%), premature atherosclerosis (20.8%) and dyslipidemia (17.8%). From the rare specific risk factors in young patients with cerebral infarction were migraine with aura in combination with other risk factors and hypotension, and cerebral vasculopathies. The majority of subtype of cerebral infarction was undetermined (34.7%), followed by other determined etiologies (19.7%). Among the category of undetermined etiology, incomplete evaluation (71.1%) was predominant. Most of the patients demonstrated good functional outcomes, at the time of hospital discharge, 86.9% patients had Rankin Scale scores in the range of 0-2 points. Conclusions Young adults with cerebral infarction account for 20.1% of all stroke patients in tertiary referral hospital in Ulaanbaatar. Risk factors, including conventional and specific causes in combination relatively prevalent in young adults, and a high rate of the patients are categorized under conventional, other determined and undetermined etiologies. Cerebral infarction in the young requires a different approach to investigation and management than ischemic stroke in the elderly given differences in the relative frequencies of possible underlying causes. The results show the needs for persistent management of conventional risk factors and properly patient investigation to determine etiology of cerebral infarction in young patients in Mongolia.

Background. There are varieties of supports from Mongolian government and health organizations to people with epilepsy. However, epileptics are often socially discriminated due to the negative public attitudes, misconceptions, false beliefs and wrong decisions. Because of this they miss out their right to study or work. Under the aim of providing right information and knowledge about epilepsy to public, carrying out continuous health educational trainings and studies among population is very important to reduce negative attitude towards epilepsy, to prevent from epilepsy stigma and to improve patients’ quality of life.Goal. The objective of this study was to assess the understanding, knowledge and attitude towards epilepsy among population in Ulaanbaatar and to determine some influencing factors.Methods. Questionnaire was carried out within randomly selected 700 people from 6 districts in Ulaanbaatar city.Results. Participants’ age range was from 16 to 64 years and average age was 36.0 (SD 9.34). 64.1% (449) participants out of all had some understanding and knowledge about epilepsy while they possess high school and university educational degree. 42.2% (295) participants had some knowledge about causes of epilepsy, how to react and how to give a first aid for epilepsy patients. However, 57.8% (405) participant out of all involved in the study had not enough knowledge about epilepsy. 29.7% (208) participant had a positive attitude towards epilepsy.ConclusionPersonal age, educational level, information accessed and interaction with people with epilepsy influences to the knowledge about epilepsy.

Background Ischemic stroke or cerebral infarction in young adults (20-50 years) is relatively frequent, accounting for more than 10%-26% of all first strokes and its incidence rises steeply with age. Causes of “Young stroke” are heterogeneous and while it generally has a good prognosis, it has a significant socioeconomic impact, including functional deficits and financial costs. The most frequent causes of cerebral infarction in young adults are cardio-embolism, hypertension, premature atherosclerosis, migraine, smoking and hypercoagulable states. Objective The aim of this study was to compare characteristics of cerebral infarction between young (20-49 years) and old (50-89 years) patients undergoing investigations and treatment according to one common protocol in the tertiary hospital. Methods This Descriptive case series study was conducted in Department of Neurology of First State Central Hospital from October 2014 to July 2016. During this study, we observed 220 patients with first-onset of cerebral infarction from which 90 young patients (under 50 years) and 130 old one (above 50 years), based on prospective study. Data regarding the etiology and risk factors of the stroke, clinical manifestations, and diagnostic test results of patients were examined during their hospital treatment as well as a NIHSS, modified Rankin Scale scores, and Barthel Index at admission and discharge, also at 21 day. Stroke subtyping was conducted in accordance with the Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria. Results In total, 220 patients with cerebral infarction were included, from which 90 (40.9%) were 20-50 years and 130 (59.1%) were 50-89 years. The proportion of males was higher among both groups: 61.1% vs. 70.0%. Common causes for cerebral infarction in the young patients were current smoking (53.3.1% vs. 37.8%), long-term alcohol consumption (51.1 vs. 12.3), cardiac embolism (36.0% vs. 16.2%), migraine with aura (25.5% vs. 12.2%), infective diseases (15.6% vs. 0.8%), and oral contraceptive use (14.4 vs. 0%). Leading causes for ischemic stroke in old patients were the conventional risk factors such as hypertension (75.4% vs. 38.9%), atherosclerosis (66.9% vs. 31.1), coronary artery disease (24.3% vs. 12%), and diabetes mellitus (26.9% vs. 6.7%). Most of the young stroke patients demonstrated good functional outcomes, at the time of discharge (71.1% vs. 60%) and three weeks (86.6% vs. 66.2%) patients had Rankin Scale scores in the range of 0-2. Conclusions There are significant differences between young and old patients with cerebral infarction regarding to risk factors, etiological subtypes and improvement of functional deficits associated with the stroke. However, severity of stroke on admittance is similar but three weeks outcome is different among young and old patients with relatively rapid improvement of functional deficit in young stroke patients than old one.

BACKGROUND: Epilepsy is a common neurological disease, which need to health care and public health servicetopicality that is a very important for people with epilepsy (PWE). Therefore psychosocial problemssuch as depression, anxiety, and stigma, discrimination from other people, negative public attitude andmisunderstanding significantly influence on their psychosocial well-being and quality of life. PURPOSE: To study an anxiety and depression in people with epilepsy.MATERIALS AND METHODS: 77 patients aged between 20 and 60 were included in our study group. In order to identify psychosocial problems we used the Beck Depression Inventory (BDI), the Beck Anxiety Inventory (BAI) and a tenitem measure of felt stigma (Austin, Dunn et al) for this cross-sectional study.RESULT: There were 77 PWE and slightly more 53.2% male, 46.8% female and, in comparison group. Of theseparticipants 44.2%were married, 75.3% unemployment. The frequencies of anxiety symptoms in PWEwere 31.2% very anxiety, 32.5%anxiety and 36.4% not anxiety, the rates of depressive symptoms inPWE were18.2% very depressed, 19.5% depressed and 62.3% not depressed, respectively. All ofthe 62.3% PWE felt stigma. Considering the age, psychological problem, some of the variables ofthe participants, the age of the people with epilepsy was associated with depression and the stigmascores, negatively (r = -0.2, p = 0.05; r = -0.2, p = 0.05).We observed a positive correlation between BDI and BAI scores in PWE (r = 0.6; p = 0.01).There hasalso the relationship between stigma and anxiety, depression, social-interaction of the attitude scoresin PWE (r = 0.5, p = 0.01; r = 0.5, p = 0.01; r = 0.4, p = 0.01), whereas that the correlation statistic didnot indicate a relationship between the duration of the epilepsy and anxiety, depression, stigma andsocial-interaction’s scoresCONCLUSION: Of the people with epilepsy 31.2% have very anxiety, 33.8% have anxiety and 18.2% have verydepressed, 19.5% have depressed. This reveals that it has positive relationship with social-interactionand attitude. Frequency of epileptic seizures influences the anxiety and depression of the people withepilepsy and thus worsens their stigmatization.

Stroke is a major healthcare problem ranking as the second leading cause of death and the first cause of disability in the world. The stroke incidence in the world varied from 100 to 336 per 100.000 people per year. In different world regions the incidence of stroke ranges between 134.9 to 336.3 new cases per 100.000 inhabitants and the annual frequency of deaths within 36.7 to 136.7 per 100.000 events, while the frequency of stroke and mortality in Mongolia is within the upper limits of the above mentioned indicators. A recent report of the WHO MONICA Project documented that stroke incidence ranged between 101-285 in males and 47-198 in females per 100,000 people aged 35 to 64 years in 16 countries involved in this study. In the United States the average annual incidence rates of all strokes under the age of 55 years was 113.8 per 100,000, while that for cerebral infarction was 73.1 per 100,000. More than 10% of patients with cerebral infarction were 55 years or younger. Almost two thirds of the global burden of stroke is borne by those in developing countries. Recent study in Mongolia showed that young adults account for 21%-26% of all stroke patients as opposed to 10%-13% Western countries. In this review we sought to discuss the tissue-based definitions, epidemiological trends, risk factors, and specific causes associated with stroke in the young.

Background: Acute respiratory viral infection caused by human new coronavirus that was reported in last December of 2019, is becoming the most serious issue worldwide. During human coronavirus infection, upper and lower respiratory symptoms are common. However, other systemic symptoms, especially neurological signs were reported previously. It is further noted that sometimes the neurological manifestations can precede the typical features like fever and cough and later on typical manifestations develop in these patients. Purpose: to analyze information of neurological manifestations related to COVID-19 disease and possible way of affection of nervous system by SARS-CoV-2 virus. Material and Methods: We searched Medline, PubMed, Central and Google Scholar, Web of Science for related published articles and case reports, using keywords such as “COVID-19”, “Coronavirus”, “pandemic”, “SARS-CoV-2”, “Neurological manifestations”; “Complications”; “Clinical characteristics”. There were found and considered few articles of clinical characteristics and case series reports related to COVID-19 with neurological manifestations and complications, also articles of SARS-CoV-2 virus affection to nervous system. Results Neurological manifestations including headache, dizziness, myalgia, confusion, and hyposmia were observed during COVID-19 in 6-36.4% cases. A few cases with COVID-19 showed more severe symptoms such as stroke, polyneuropathy, encephalopathy, myelitis and acute necrotizing encephalitis. SARS-CoV-2 viral infection pathway may be two different ways, namely, a) binding ACE-2 receptor on capillary endothelium and causing inflammation where then can cross blood-brain barrier and to emerge brain tissue damage; b) entering via nasal epithelium where the bipolar cells locate, from there directs to central nervous system to cause neuronal injury through olfactory bulb.
Conclusion: neurological manifestations are relatively common in COVID-19, however, there is lack of evidence-based study. There may have two possible pathways of SARS-CoV-2 to affect nervous system, but is required necessary further elaborately study

Introduction: There are still MS has been diagnosed in Mongolia during last 40 years, there is a lack of information regarding to geographical distribution and ethnic differences in origins of MS. That is why our main purpose is to do study the prevalence rate of MS in populations of UB city. Goal: To determine the prevalence rate of MS in adult populations of Ulaanbaatar (UB) City.Materials and Methods: To study the morbidity of MS in Mongolia using statistical data; to determine the prevalence rate of MS using hospital-based design and following the “door-to-door” methods. Results: MS morbidity analysis of five-year statistical data (2003-2007) showed an average of 178 per 100000; morbidity level in both rural and urban settings was 7.0 per 100000; among them 43% were patients in the 30-40-year-old age group. According to our study the prevalence rate of MS in UB City for a adult population of 100,000 above the age of 16 was 10.3; Rate of prevalence in females is 4 times more than in males (15.8 vs 4.2); the highest prevalence rate in females was in the 40-49 year-old age group (31.3); in males was in the 50-59 year-old age group (14.9). It is shown by disease dominating middle-aged women and older men relatively (p<0.05). In our clinical study of 67 MS patients, the mean age was 41.79±8.76. The age at onset ranged from 18-50 years (31.5± 9.2-for females; 37.3± 9.7-for males). Conclusion: The average morbidity rate of MS in Mongolia by statistical analysis from 2003-2007 data was 7.0 per 100,000 people; with a female-to-male ratio of 2:1. The prevalence rate of MS in adult populations of Ulaanbaatar for 100,000 people was 10.3; with a “chi”-square for females that was 4 times higher compared to males.

Introduction: However MS having been diagnosed in Mongolia during the last 40-50 years, there are difficulties in its differential diagnoses from other demyelinating diseases. Therefore our main reasons are to do study the clinical characteristics of MS with comparison MRI findings.Goal. To determine the clinical characteristics of MS with correlations to MRI-findings using caseobserved methods.Materials and Methods: Used the “door-to-door” method to be find out and work with that 115 subjects, from which selected according to the diagnostics criteria 67 patients with following reexaminations for confirmation of diagnosis, during next 2 years these cases were studied with MRI and VEP to compare clinical manifestations, common forms by age and sex. 34 subjects for MRI and 6 patients for VEP examinations undergone respectively; SPSS-15.0 used to analyze collected materials; for description of the data used mean, median, standard deviation; to detect inter variable association used “t”-test, “Chi-square”, correlation coefficient; P-value for all significant cases.Results:Among sixty-seven MS patients the main clinical forms were cerebrospinal (55 patients – 82.1%), pure cerebral (4 patients–6.0%) and pure spinal–(8 patients–11.9%). Clinical course was relapsingremitting in 39 patients (58.2%); secondary-progressive in 12 patients (17.9%); progressiverelapsing in 13 patients (19.4%), and primary-progressive in 3 patients (4.5%). The most common location of first attacks was pyramid system–46,3%, visual pathway, predominantly causing damage to the optic nerve–43.3%, followed by the spinal cord - 37.3%, optic-spinal-20.9% and brainstem–10.3%. Pyramid, sensory and vision-dissociated symptoms were also reported in 77% of patients, and paroxysmal symptoms in 67% of patients. The MRI scan performed in 34 patients–50.7% determined dissemination-in-time 10(29.4%) and in-space 18(53%). On MRI scans in T2-weighted images, 16 hyperintense lesions within the periventricular white matter were found (56,3%); 3 lesions in area pons and cerebella (5,95%); 13 lesions in spinal cord white matter (30,4%) and 2 lesions in nervous opticus tract (7,45%). Conclusions: The main clinical forms were cerebrospinal (82%) and opticospinal, which formed more than half of the cases, in which relapsing-remitting (58%) and progressive-relapsing courses (19%) predominated. The relapsing and progressing course of the disease was directly determined by clinical symptoms and MRI scan findings of dissemination-in-time and in-space of existing lesions. As MS can be asymptomatic, it was found that MRI-findings were positive (11.8%) even when clinical manifestations disappeared.

Background: Migraine is a chronic and recurrent vascular headache, and is one of the most common diseases in the general population. Evidence suggests that migraine is associated with an increased risk of silent infarct lesions and high signal intensities observed at the time of performing magnetic resonance imaging (MRI). Objectives: To determine the frequency of hyperintense foci in migraine patients and the relationship with migraine headache characteristics and cerebrovascular risk factors. Material and Methods: Eighty patients with migraine headache (31 with aura and 49 without aura) were enrolled and interviewed. Twenty headache-free individuals of the same age range were used as controls. Information of patients with migraine, on their headache characteristics (severity, frequency, and mean disease duration) and other related data was obtained by completing a clinical checklist. Subsequently, brain magnetic resonance imaging (MRI) was performed in the study and control groups, and each patient was then evaluated for hyperintense lesions. Results: Of the 80 patients with migraine, 26 (32.5%) had silent hyperintense infarct lesions on MRI scan while the age-matched control group (n=20) did not found such abnormalities (32.5% vs 0%). The mean age of the patients with hyperintense foci was 38.9 years while those with no lesions was 31.3 years (p<0.001). Amongst the 65 hyperintense lesions detected in this study, both side supratentorial foci represented in 61.5% patients (n=40) in the whole brain, while 38.5% of the lesions (n=25) were found in subtentorial white matter. Cerebrovascular risk factors such as serum cholesterol, oral contraceptive use, and body mass index (BMI) were not significantly different in these two age groups (p>0.05). The lesions were found significantly more frequently in the female patients who experienced chronic migraine with aura and smoking (p=0.05). Conclusion Our study shows that disease duration has a key role in the formation of hyperintense brain lesions. Certain cerebrovascular risk factors such as serum cholesterol, oral contraceptive use and BMI, do not affect the presence or absence of such lesions, suggesting that the relationship between migraine and these lesions may be directly due to the effects of migraine itself.

Background: The frequency of cerebral infarction and stenosis of intra- and extracranial arteries may be vary with age-group and gender. Objective: This study was conducted to clarify the risk factors and characteristics of cerebral infarction and stenosis of vessels in Mongolian young adults. Methods: This was a prospective study, from October 2015 to July 2020, of 100 patients below 50 years diagnosed with acute cerebral infarction. Patient characteristics were compared according to sex (61 males and 39 females) and age group (29 patients were below 34 years and 71 patients were 35–49 years). Characteristics of acute cerebral infarction were studied by DWI-diffusion weighted MRI imaging. Stenosis of intra- and extracranial arteries was diagnosed by duplex sonography, head and cervical magnetic resonance angiography (MRA). Results: Leading causes for cerebral infarction in the young patients were hypertension (71%), smoking (57%), dyslipidemia (45%), diabetes (33%), and migraine with aura (25%). Lacunar Infarction was most common in our patients (33%). Partial anterior circulation infarction was predominant in males (45.9% vs 38.5%; P<0.05) and posterior circulation infarction in females (23.1% vs 11.5 %; P<0.05). Small artery atherosclerosis was found in 33% cases, with higher prevalence in patients of the 35–49 years age-group. Intracranial stenosis was more common than extracranial stenosis, and middle cerebral artery stenosis was most prevalent (38.9%). Stenosis in the anterior circulation was more frequent than in the posterior circulation (P<0.001). Conclusions In these young patients, hypertension, smoking, dyslipidemia, diabetes, and migraine with aura were common risk factors. Intracranial stenosis was most common, particularly in the middle cerebral artery.