Background: Stroke is the leading cause of brain death. Determining brain death has many benefits, the most important of which is to provide organ donation. However, to date, there is no reliable predictive criterion for determining brain death in stroke. Aim: To study the possibility of predicting brain death by analyzing risk factors, clinical and baseline tests in cases of stroke-related death. Materials and Methods: A prospective observational study was conducted on stroke deaths in the Stroke Department of Third State Central Hospital from January 1 to December 31, 2018, and statistical analysis was performed using SPSS 22.0. Approval for the study was obtained from the Research Council of the Third State Central Hospital. Result: The study included 138 (13.1%) death cases out of 1056 cases hospitalized with a stroke. Of these 138 cases, 90 were intracerebral hemorrhagic stroke (ICH), 30 were subarachnoid stroke, and 18 were ischemic stroke. Death was primarily detected in the age of 50-59 in all study groups (p=0.006, p=0.049). The clinical severity was statistically significant (p<0.05) in the ICH group, with a GCS score of 4.58±2.43 and an NIHSS score of 31.54±7.227. Risk factors for brain death were most common in the ICH group, with arterial hypertension (114 cases) and HCV infection (23 cases) (p<0.0001, respectively). Conclusion ICH, clinical severity, arterial hypertension, and chronic hepatitis B virus infection are predictive factors of brain death.

Background: The rate of brain death organ donation is continuously increasing worldwide. Intracerebral hemorrhage (ICH) is the leading cause of brain death and accounts for 30-68% of organ transplant cases. Aim: To identify the predictors of brain death (BD) upon admission to the intensive care unit (ICU) of comatose patients with spontaneous intracerebral hemorrhage (ICH). Materials and Methods: A prospective observational study was conducted on ICH deaths in the Stroke Department of Third State Central Hospital from January 1 to December 31, 2018, and statistical analysis was performed using SPSS 22.0. Approval for the study was obtained from the Research Council of the Third State Central Hospital. Result: The study included 138 (13.1%) inpatient stroke deaths in the Stroke Unit, of which 90 were ICH, 30 subarachnoid hemorrhage, and 18 ischemic strokes (p=0.006). Considering the age limit of up to 70 years, which is the criterion for brain-dead donors in Mongolia, out of the 42 ICH cases, 24 (57.1%) were male, and 18 (42.9%) were female (p=0.326). The mean age of these cases was 52.88±7.34, the mean GCS score at the time of hospitalization was 4.55±2.56, the mean NIHSS score was 31.5±7.81, and the mean volume of hematoma formed in 30 cases was 175.92±169.96 cm3 (each p<0.05). Mechanical ventilation durations occurred mostly in the first 0-2 hours and 2-6 hours (31% each), with the longest duration at 6-12 hours. Conclusion Patients with ICH who present with poor mental status on hospital admission (GCS<7), severe stroke on clinical assessment (NIHSS>32), extensive cerebral hemorrhage on computed tomography (CT) imaging, and early requirement for mechanical ventilation have a high likelihood of progression to brain death. These patients therefore represent a significant potential pool of organ donors.

Background: Non-traumatic intracerebral hemorrhage (ICH) represents the most devastating subtype of stroke, charac terized by spontaneous bleeding into the brain parenchyma. This neurological emergency carries a burden of mortality and long-term disability worldwide. Timely identification causal pathways is priority objective for adequate primary and secondary prevention of ICH. Risk factors may differ between ICH subtypes, and stratified approaches to management may be appropriate. Aim: This study is to identify cause and risk factors of ICH. Materials and Methods: A single centre descriptive study was carried out in Stroke Center of the State Third Central Hospital, Mongolia, including 718 consecutive acute patients with ICH during October 2022 to September 2024. Patients were classified using SMASH-U, an etiological based classification system. Results: Out of a total of 718 cases diagnosed with ICH, hypertension caused 75.3%, amyloid angiopathy 12%, undetermined 7%, structural lesions 2.92%, systemic disease 2.37%, medication 0.48% in 718 ICH patients. The mean age of the cases was 57.5 жил, and was the most common in men of the 50-59 age group (p<0.001). The main risk factor in hypertension and amyloid angiopathy groups was arterial hypertension (93.7%), in undetermined group alcohol consumption (48%), in structural group AVM and other vascular causes (23.8%), in systemic group chronic kidney insufficiency (29.4%), in medication group atrial fibrillation (100%), respectively. Conclusion 1. ICH was mostly caused by hypertension, amyloid angiopathy, systemic disease. 2. Arterial hypertension, heart disease, atrial fibrillation, previous stroke, oral anticoagulants, smoking, alcohol consumption, obesity/BMI≥25, liver cirrhosis, chronic kidney insufficiency, AVM and other structural anomalies were the most common risk factors.

Background: The incidence of metastatic melanoma (MM) has been steadily rising, and it is the third most common metastatic lesion to the central nervous system. Spinal intradural extramedullary MM is rare, and it is associated with coexisting or antecedent brain metastasis. A 66-year-old patient presented to us with a seizure, malaise, low back pain, progressive weakness of both lower limbs, and bladder dysfunction. She had a known history of MM of the brain, which was diagnosed just 5 months before the current presentation. 5 months ago, she was admitted to the Neurosurgery clinic and underwent an excision of one of three metastases in the brain. The histopathological findings were consistent with malignant melanoma that was confirmed with immunohistochemistry examination (positive for S-100, Melan-A, and HMB-45). The patient underwent an extensive magnetic resonance imaging scan of the brain and lumbosacral region that suggested T1 hyperintense, T2 hypointense, intradural extramedullary altered signal intensity lesions at the cauda equina region as well as widespread leptomeningeal disease. Here, we are discussing an unusual case with a comprehensive review regarding the pathogenesis, diagnosis, and prognosis of the tumor. Conclusion Brain metastasis from melanoma is associated with a poor prognosis, with an average survival of only 4–6 months after diagnosis. Leptomeningeal metastasis and extramedullary metastatic involvement indicate the terminal stage of the disease. Although the overall prognosis remains unfavorable, emerging mechanism-based therapies have improved survival and quality of life for some patients. Nevertheless, early diagnosis of melanoma remains the key factor in improving patient outcomes.

Background: Malaria is caused by parasite of the genus Plasmodium and considered one of the biggest public health issues because almost half of the world’s population is at risk of contracting malaria. It causes 2% of the world’s total deaths and millions of clinical infections. In 2022, 94% of cases and 95% of deaths occurred in the WHO African Region. Cerebral malaria the most severe neurological complication of infection with Plasmodium falciparum malaria. It is a clinical syndrome characterized by coma and asexual forms of the parasite on peripheral blood smears. The neurological complication, induced by cerebral malaria is irreversible and lethal, therefore it is of great significance to unravel its exact etiology, which may be beneficial for the effective management of this severe disease. In Mongolia, malaria normally not present unless the disease was contracted abroad. Considerable attention in malaria control and elimination is needed, yet, increasingly, domestic hospitals are unfamiliar with it, and so there is a risk of being overlooked. The following is the second case, to our knowledge, of cerebral malaria in Mongolia. Conclusion Although Mongolia is not a malaria-endemic region and routine malaria testing is not commonly performed, the number of imported cases is increasing due to the growing mobility of the population—travel, study, tourism, and peacekeeping missions to Africa and Southeast Asia. Therefore, neurologists should be aware of the possibility of cerebral malaria when evaluating patients with neurological deficits who have a history of travel to malaria-endemic areas. This case highlights important clinical, imaging, and laboratory considerations for suspecting and diagnosing malaria in such patients.

Background: Adult-onset leukoencephalopathy with axonal spheroids and pigmented glia (ALSP) is a rare neurodegenerative disease characterized by cerebral white matter abnormalities, which leads to progressive cognitive and motor dysfunction that usually presents in a middle-age. We present the pedigree, clinical, and imaging findings of familial cases with similar clinical features suggestive of progressive multiple sclerosis. Among our cases, two had died and the remaining one case is still alive, but with clinical symptoms getting worse, such as unable to verbally express themselves, unable to take care of themselves, worsening social relations and work abilities. Conclusion Because the clinical features and neuroimaging findings of inflammatory and neurodegenerative disorders of the nervous system often overlap, the definitive diagnostic test for ALSP (Adult-onset Leukoencephalopathy with Axonal Spheroids and Pigmented Glia) is genetic testing to identify CSF1R gene mutations. Although genetic testing is currently unavailable, it is advisable in clinical practice to apply diagnostic criteria and pay close attention to family history and characteristic neuroimaging findings when evaluating patients with progressive motor, cognitive, and language decline in order to suspect this condition.

Background: Multidrug-induced long QT syndrome is a serious heart rhythm disorder where multiple medications prolong the QT interval on an electrocardiogram, increasing the risk of a potentially fatal arrhythmia. Long QT syndrome is characterised by heart rate corrected QT interval prolongation and life-threatening arrhythmias, such as polymorphic ventricular tachycardia, Torsades de pointes leading to syncope and sudden death. Case: 21-year-old woman required resuscitation from an apparent cardiac arrest that had occurred after status epilepticus. The woman was diagnosed with long QT syndrome, cardiac channelopathy. She had a long history of syncope, seizure and palpitations. Family history was non-contributory. Home medications included levetiracetam 500 milligrams orally twice and fluoxetine 20 milligrams orally once a day which the patient reported non-compliance with. Levetiracetam is a widely used anti-epileptic medication secondary to its favorable safety profile. To our knowledge, there are few other case reports documenting torsades de pointes after levetiracetam administration, and specifically our case report will be the first documenting cardiac arrest after multidrug administration. Long QT syndrome is not often included in the differential diagnosis of epileptic and non-epileptic seizures. Early recognition of the syndrome is very important because of prognostic and therapeutic consequences. Conclusion Although no hereditary cause was confirmed, this case represents Torsades de Pointes triggered by multiple medications—including long-term low-dose carbamazepine, fluoxetine, diazepam, and high-dose levetiracetam—on a background of probable Romano–Ward syndrome or predisposition to QT prolongation. The arrhythmia progressed to cardiac arrest, requiring ICD implantation.

Introduction: In Mongolia, data on the etiology and risk factors of cardioembolic stroke (CES) is scarce and few clinical studies have been performed to date. Timely identification and control of cardiovascular risk factors are priority objectives for adequate primary and secondary prevention of CES. Goal: The goal of this study was to describe risk factors for CES in our setting. Results: The case-control study enrolled a total of 525 subjects. CES was detected in 63 (35.7%) out of 176 (33.5%) ischemic stroke patients with a predominance in age group of 60-69 and men (33%). The main risk factor of CES was non-valvular atrial fibrillation (AF). AF especially paroxysmal AF increased the risk of CES by 4.6 times (p=<0.0001, OR 4.6, 95% CI 1.4-44.6). The second main cerebrovascular risk factors were hypertension and dyslipidemia. Conclusion CES accounted for 1/3 of ischemic stroke. The commonest underlying medical conditions were non-valvular atrial fibrillation, hypertension, dyslipidemia, alcohol consumption and obesity. Hence, all patients with hypertension and non-valvular AF should be meticulously screened for prevention of CES.