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: Carpal tunnel syndrome (CTS) is a disease caused by compression of the median nerve in the carpal tunnel and is considered to have an individual, occupational, and socioeconomic impact. Aim: To study the risk factors for CTS among hospital floor cleaners. Materials and Methods: A cross-sectional study was conducted among floor cleaners at the Third State Central Hospital. Clinical and electrophysiological severity of CTS were evaluated using standardised scales, and symptoms were assessed with the self-administered Boston Questionnaire (BQ). Demographic and non-occupational factors, as well as durations of current and previous occupations, were recorded. The diagnosis was confirmed by electrophysiological analysis. Each assessment was categorised as mild, moderate, or severe. Statistical analysis was performed using SPSS 27.0. Result: The prevalence of CTS among floor cleaners was 39% (32/82) (p < 0.001). In the simple logistic regression, comorbidities (OR, 2.50 [95% CI, 1.02-6.16]), smoking (OR, 3.90 [95% CI, 1.12-13.57]) and in the multiple logistic regression, only comorbidities (OR, 2.90 [95% CI, 1.03-8.16]) were the predictors of CTS. Conclusion The risk of developing CTS among hospital floor cleaners is influenced by BMI, smoking, and comorbidities, including diabetes mellitus.

Background: Carpal tunnel syndrome (CTS) is the most common compressive mononeuropathy leading to disability. CTS is more common among professionals, such as waiters, cleaners, gardeners, and seamstresses. It is necessary to assess clinical severity and implement treatment and secondary prevention for CTS. Aim: To study the correlation between clinical and electrophysiological examinations in floor cleaners diagnosed with CTS. Materials and Methods: The study included floor cleaners at the Third State Central Hospital diagnosed with CTS. Clinical and electrophysiological analyses were used to confirm the diagnosis. The Boston Carpal Tunnel Questionnaire (BCTQ) was used to assess pain and functional status, and neurologic examination was used to confirm the clinical and diagnostic findings. Electrophysiological examination and BCTQ results were categorised as mild, moderate, or severe. The study employed a single-point analytical design, and statistical analysis was conducted in SPSS 27.0. Result: The study included a total of n=32 CTS cases and found that the average age, high BMI, diabetes, hypothyroidism, joint disease, and previous hand fractures were more common. The primary symptom of MDS was hand tingling, which was predominantly bilateral and lasted an average of 19.06±18.87 months. Among CTS cases, when categorised by the severity of motor and sensory loss (mild, moderate, severe), smoking was statistically significant in the mild and moderate groups, but not in the severe group (p=0.027). Most symptom severity and functional status scores assessed by the BCTQ were mild to moderate. Conclusion For hospital floor cleaners, a diagnosis of CTS based on complaints and clinical assessment alone is insufficient; electrophysiological confirmation is recommended.

Background: Cerebral cavernous malformations (CCM) present with varied symptoms and are diagnosed only on MRI, which shows characteristic appearances. Genetic factors play a role, with familial cases following an autosomal dominant inheritance pattern. Case: This is the clinical case of a 48-year-old woman with a history of long-standing arterial hypertension. She was admitted to the Stroke Department with headache, nausea, vomiting, right-sided sensory disturbance, and dysarthria. Based on the clinical presentation and MRI, multiple supra- and infratentorial and intraxial lesions with heterogeneous components were identified, exhibiting hypointense rings on T1- and T2-weighted sequences and a “blooming” effect on T2*/GRE sequences, characteristic of cerebral cavernomas, displaying a “popcorn” appearance. Conclusion In CCM, management requires a multidisciplinary approach, with surgical resection the gold standard for symptomatic cases. Accurate determination of familial or sporadic origin is crucial for tailored treatment.

Background: Choriocarcinomas after full-term pregnancies are a rare entity. Case presentation: A 34-year-old woman was admitted to the hospital with a seizure in a comatose state. A computed tomography scan revealed an intracerebral haemorrhage in the right parietal region. A chest CT scan showed a single metastatic lesion in the right upper lung field. The patient delivered a viable infant at 39 weeks of gestation, 4 months before the hospitalisation. Her pregnancy course was uncomplicated. Despite receiving intensive treatment, the patient died 1 day later. Choriocarcinoma was diagnosed at the autopsy. Conclusion Metastatic choriocarcinoma should always be in the differential diagnosis for women of childbearing age presenting with unexplained stroke-like symptoms.

Background: Primary central nervous system lymphoma (PCNSL) is a rare form of extranodal non-Hodgkin lymphoma that is confined to the brain, spinal cord, leptomeninges, or eyes. Case: Our patient was a 52-year-old immunocompetent male who presented with progressive ataxia, dizziness, weakness and pain in both legs, imbalance, nausea, bladder/bowel retention and fever for over 18 months. After repetitive brain and spinal MRI, he was diagnosed with encephalomeningomyelitis and received four courses of steroid therapy, but his clinical symptoms continued to worsen. He was unable to undergo brain tissue analysis due to his persistent fever. We present a case of PCNSL based on the history, clinical presentation, repeated brain imaging, cerebrospinal fluid analysis, and clinical treatment. Conclusion Early diagnosis through accurate interpretation of imaging and timely management is crucial for improved outcomes in PCNSL.

Background: Multiple sclerosis (MS) is an autoimmune inflammatory neurodegenerative disease of the central nervous system and a major cause of disability in young adults. MRI is essential for diagnosis and monitoring, while early evaluation of structural brain changes is important. Aim: To evaluate brain volumetric changes using automated MRI analysis in patients with MS. Materials and Methods: This case–control study included 50 MS case patients and 50 controls patients examined between 2020–2023 at the Third State Hospital. T1-MPRAGE images were analyzed using volBrain automated segmentation software. Result: The mean age of MS patients was 45.5±11.8 years. Compared with healthy controls, the MS group showed significantly lower total grey matter volume (p=0.002), cortical grey matter volume (p<0.001), subcortical grey matter volume (p=0.006), and cerebral volume (p=0.02). Significant volume reductions were also observed in the temporal (p=0.006) and occipital (p<0.001) lobes. Deep grey matter structures, including the thalamus (p=0.001), caudate nucleus (p=0.009), putamen (p=0.008), and nucleus accumbens (p<0.001), also showed significantly reduced volumes. Disease duration was negatively correlated with total grey matter volume (r=−0.30, p=0.02), thalamic volume (r=−0.28, p=0.04), and occipital lobe volume (r=−0.43, p=0.002). Disease duration was also significantly associated with spinal cord involvement (p=0.01) and grey matter volume (p=0.04). The number of relapses was negatively correlated with total brain volume (r=−0.28, p=0.046). Conclusion Patients with MS demonstrated decreased grey matter volume, particularly within deep grey matter structures, along with increased abnormal white matter volume, suggesting the coexistence of neurodegeneration and demyelination in MS. Brain volume loss in MS appeared to occur independently of aging. Automated quantitative MRI analysis may provide important diagnostic value in detecting structural brain changes associated with MS.

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.