Background: Aetiological mechanisms of demyelinating diseases underlie a very heterogeneous clinical course, ranging from relapsing to progressive, with a longer disease duration leading to physical and cognitive disability. Aim: To identify factors in the development of long-term disability in demyelinating diseases. Materials and Methods: A cross-sectional study was conducted among 64 patients with multiple sclerosis and 33 patients with NMO treated at the Third State Central Hospital. We assessed demographic and clinical data, including the Expanded Disability Status Scale (EDSS). Statistical analysis included descriptive statistics, t-tests, chi-square tests, analysis of variance, correlation, and regression. Result: In MS, relapses (≥1) within 1.0 years of MS onset (OR=5.5, 95% CI 1.11-26.69, p=0.037), optic neuritis (OR=4.3, 95% CI 1.02-21.67, p=0.014), relapse frequency (≥3) (OR=6.6, 95% CI 1.39-31.3, p=0.018), myelitis frequency (≥2) (OR=5.5, 95% CI 1.42-21.67, p=0.014), in NMOSD, time from disease onset to diagnosis (≥3 month) (OR=7.9, 95% CI 1.04-60.7, p=0.046), years of diagnosis (≥3 years) (OR=6.3, 95% CI 1.15-34.12, p=0.034) contributed to disabilty worsening outcomes. Conclusion Disability in demyelinating diseases is affected by many factors.

Background: Simultaneous multiple intracerebral haemorrhages (SMICH) is hemorrhage in different arterial territories and are a rare clinical entity. The primary cause of single ICH is hypertension; however, the causes and risk factors of simultaneous multiple ICH are still unknown. Aim: To clarify the aetiology, risk factors and functional outcome of SMICH compared with solitary intracerebral haemorrhages (ICH). Materials and Methods: A total of 718 consecutive patients with spontaneous ICH admitted to our hospital were prospectively studied. Nine SMICH cases were identified, and 19 risk factors, clinical and neuroimaging variables were compared between SMICH and solitary ICH cases using the unpaired t-test, chi-square test, and multiple logistic regression. Result: 709 (98.75%) patients with ICH and 9 (1.25%) patients with SMICH were enrolled in the study. The age, sex distribution, and other associated risk factors were comparable between the groups (all P>0.05). By SMASH-U classification, arterial hypertension was identified in 6 (66.7%), and it was the most common cause in the SMICH group. Bilateral thalamic or putamenal haemorrhages (33.3% versus 33.3%) were the most common combinations of simultaneous bleedings. Age and NIHSS at admission were associated with 90-day mortality in multivariable analyses (OR 1.018; 95% CI, 1.000-1.036; p=0.044; versus OR 1.080; 95% CI, 1.029-1.135; p=0.002), but GCS was not (OR 0.834; 95% CI, 0.734-0.948; p=0.006). Conclusion Patients with SMICH have risk factors and clinical characteristics similar to those of patients with solitary ICH, but they have a much poorer outcome.

Background: Non-traumatic intracerebral haemorrhage (ICH) is a neurological emergency, because it carries a burden of mortality and long-term disability worldwide. Aim: To compare urban and rural differences in hospitalisation due to ICH. Materials and Methods: An analytical study was conducted among ICH cases admitted to the Third State Central Hospital between 2022 and 2024, and statistical analysis was performed using SPSS 27.0. Result: The study included 373 cases of acute ICH diagnosed by computed tomography between 2022 and 2024 at the Third State Central Hospital, of which n=313 were from Ulaanbaatar city, and n=60 were transported from the rural area. Compared to the urban group, the rural group had fewer males, but a history of arterial hypertension prevailed (98.3% vs 90.1%, p=0.041), and lower blood pressure at the time of hospitalisation (systolic pressure 159.7±34.7 mm Hg vs 179.0±32.9 mm Hg, p<0.001; diastolic pressure 99.7±21.4 mm Hg vs 106.5±21.8 mm Hg, p=0.026). Cases in the rural group had a longer hospital stay from the onset of clinical symptoms than those in the urban group (12.1±17.9 hours vs 4.2±4.3 hours, p=0.001). Multivariate regression analysis showed that lower hematoma volume (adjusted odds ratio [aOR] 0.92, p=0.047) and lower NIHSS score at hospital admission (aOR 0.67, p<0.001) were associated with better outcomes. However, multivariate regression analysis showed that hospital admission NIHSS score was the only risk factor directly associated with mortality after 3 months (aOR 1.14, p=0.005). Conclusion Our study found that indicators for patients transported from rural areas with IHC were no different from those for patients in urban areas. On the contrary, mortality was independent of length of hospital stay and residency.

Background: Progressive supranuclear palsy (PSP), a rare neurodegenerative disorder, is mainly characterised by supranuclear palsy, trunk imbalance, and cognitive impairment. Its prevalence is believed to be high, although it remains underdiagnosed. Various clinical presentations have been linked to this entity, often making its diagnosis difficult and leading to delays of three to four years before it is established. PSP diagnosis mainly relies on clinical data and can only be confirmed with the neuropathological findings at autopsy. However, recent research indicates that neuroimaging, namely, brain MRI, can aid in earlier diagnosis. Case presentation: We report the case of a 60-something-year-old male with a history of recurrent and unexplained falls over the last few years that had been wrongly attributed to Parkinson’s disease. He initially presented complaining of ataxia and a tendency to recurring falls that got progressively worse, and eventually, he was not able to walk on his own. Concomitantly, there was also a cognitive dysfunction with frontal predominance. An exhaustive physical examination and clinical history revealed indicators consistent with PSP. Conclusion PSP diagnosis demands a high clinical suspicion, and hence, clinicians should have a good understanding of this disease for its early recognition. Although it is a devastating disorder and no medications that can reverse the disease course are currently available, early diagnosis of PSP may contribute to improving the quality of life of the patients and their families and prevent complications. This report highlights the importance of clinical examinations, particularly eye examinations and radiological imaging, in patients with PSP.

Background: Parry-Romberg syndrome (PRS) is a rare acquired neurocutaneous disorder characterised by progressive hemifacial atrophy involving subcutaneous tissue, muscle, and occasionally bone. Linear scleroderma (also known as Mophea en coup de sabre) is a subtype of focal scleroderma, characterised by thickening and hardening of the skin due to excessive collagen deposition in the skin and subcutaneous tissue. Both disorders occur together, although rarely. We present a case of Parry-Romberg Syndrome with Linear Scleroderma, which initially started on the left side of the face but gradually progressed over the years and, in recent years, has spread to the right side of the face and tongue, and is being treated with immunosuppressive therapy. Case Presentation: A woman in her 30s presented with progressive soft-tissue atrophy of the left side of the face, extending from the forehead and parietal region to the cheek and mandible, with associated left frontal pain and facial asymmetry. The condition had begun at approximately 10 years of age with localized alopecia and gradually progressed over several years, later involving the left side of the tongue. Examination revealed marked left-sided facial soft-tissue atrophy, tongue muscle atrophy, enophthalmos, and facial asymmetry. Electroneuromyography demonstrated chronic myogenic changes in muscles innervated by the left trigeminal, facial, and hypoglossal nerves. Brain magnetic resonance imaging showed thinning of the skull and subcutaneous soft tissues in the left frontoparietal region, with associated reduction in the size of the left orbital soft tissues and globe. Based on the clinical and imaging findings, Parry–Romberg syndrome associated with linear scleroderma was diagnosed, and immunosuppressive therapy was initiated with longterm follow-up. Conclusion Parry-Romberg syndrome is a rare, slowly progressive disorder that can involve the skin, subcutaneous tissue, muscles, bone, eyes, and nervous system. In patients presenting with progressive hemifacial atrophy, detailed neurological examination and appropriate imaging studies are important for establishing the diagnosis and identifying associated neurological involvement. This case highlights the clinical importance of recognizing Parry–Romberg syndrome and its association with linear scleroderma.

Background: Branch atheromatous disease (BAD) is believed to be one subtype of ischemic stroke brought on by plaque accumulation that obstructs or stenoses the entrance of penetrating branches. Based on clinical status, risk factors, laboratory results, and radiographic features of infarct and blood vessel morphologies, BAD has been differentiated from large-vessel occlusion and small-vessel disease. BAD-induced stroke has been strongly associated with worse outcomes than lacunar strokes, including high rates of early neurological deterioration (END), recurrent transient ischemic attacks and strokes, and disability. Determining treatment options and each patient’s prognosis depends on early identification of BAD. Case Presentation: A 34-year-old male with a history of recurrent acute ischemic stroke within 7 months, caused by stenosis of the M1 segment of the right middle cerebral artery, was hospitalized twice at the Third Central Hospital of Mongolia. Intravenous Thrombolytic therapy (tPA) was administered during each admission. Conclusion Precise diagnosis of BAD is crucial for planning subsequent treatment and secondary prevention.

Background: Non-traumatic intracerebral hemorrhage (ICH), an neurological emergency carries a burden of mortality and long-term disability worldwide. Blood pressure and level of consciousness at the admission, location and volume of parenchymal hemorrhage, volume of intraventricular hemorrhage have been most consistently linked with poor outcome. Aim: To asssess a relationship between hematoma location, volume and clinical outcome in patients with acute ICH. Materials and Methods: An analytical study was carried out in Third State Central Hospital, between 2022 and 2024, and statistical analysis was performed using SPSS 25.0 program. Results: Total of 385 cases diagnosed with acute ICH included in the study. The clinical outcomes differed significantly according to ICH location and hematoma volume (р<0.001). Lobar ICH was associated with a significantly lower risk of poor outcome (OR, 0.458 [95% CI, 0.21–0.99]), and highest risk for poor outcome in intraventricular hemorrhage (OR, 2.03 [95% CI, 1.07-3.85]). The risk of poor outcome at 3 months were the highest for brainstem (OR, 3.36 [95% CI, 1.68-6.69]), intraventricular rupture (OR, 4.91 [95% CI, 3.16-7.63]), but lowest for infratentorial-located ICHs (OR, 0.42 [95% CI, 0.23-0.76]). All receiver operating characteristic models for location-specific vutoffs had good discriminant values (area under the curve >0.8), except in predicting good outcome for cerebellum and thalamus (<10.2 ml, <6.7 ml respectively). Conclusion The interaction between hematoma volume and location exerted a direct effect on ICH outcome.

Background: Demyelinating disorders are a group of chronic immune-mediated diseases affecting myelinated axons in the central nervous system, which lead to life-long disability. In Mongolia, the last regional prevalence study was conducted in 2010. Our study objective is to describe the current prevalence of multiple sclerosis (MS) and other demyelinating disorders in Mongolia. : Aim Materials and Methods: We registered MS, neuromyelitis optica spectrum disease (NMOSD), myelin oligodendrocyte glycoprotein (MOG), and acute disseminated encephalomyelitis (ADEM) cases diagnosed according to the 2017 McDonald criteria, the 2023 NMOSD diagnostic criteria, International MOGAD Panel proposed criteria. Results: The study was conducted in all tertiary, 7 regional, and 20 provincial hospitals across Mongolia and has collected comprehensive data on 965 patients. The prevalence of total demyelinating disorders was estimated to be 27.2, MS 15.6, NMOSD 5.6, MOG 0.06, and ADEM 0.9 per 100,000 total population, respectively. The prevalence of demyelinating disorders between provinces was compared in order of geographical latitude, from lowest to highest, and was statistically significant. Latitude is associated strongly with the prevalence of demyelinating disorders (p=0.006, 95% CI 14.3-22.4, Pearson correlation=0.603) and moderately with the prevalence of MS (p=0.028, 95% CI 9.39-15.6, Pearson correla tion=0.503). Conclusion In Mongolia, the prevalence of MS has significantly increased and can be considered at medium risk, but still much lower than that in Western countries. The prevalence of NMOSD is almost similar to other Asian countries. An obvious latitude gradient for demyelinating disorders was observed in the Mongolian population.

Background: Tick-borne encephalitis is human viral infection involving the nervous system and transmitted by the bite of infected tick. The TBE Virus is distributed in different geographical areas by three widespread subtypes of the virus: The Far East, Europe, and Siberia. The Far East type has a mortality rate was 30-35%, the European type has a mortality rate of 2.2%, and the Siberian type has a mortality rate of 6-8% (A.G. Pletnev, 1998) [2].
In recent years, human cases of tick-borne infections have been reported in 19 European countries and four Asian countries (Mongolia, China, Japan, and South Korea) [3].
Human cases of tick-borne encephalitis, tick-borne rickettsiosis, and tick-borne borreliosis have been registered in Mongolia since 2005. Deaths have been reported year by year [5].
During 2005 to 2021, tick-borne rickettsiosis (71.6%), tick-borne encephalitis (17.3%) and tick-borne borreliosis (52.9%) were confirmed by epidemiological, clinical and laboratory tests at the NCZD.
Tick-borne encephalitis was registered in 63 soums of 15 provinces and 9 districts of the capital city, of which 90% were infected with tick bites in Selenge and Bulgan provinces. The average mortality rate is 4.9% (14), of which 28.6% in Bulgan province and 2.7% in Selenge province.
Tick-borne encephalitis is the leading cause of death in Bugat soum of Bulgan province and more infected men about 40 years of age [7]. Purpose : Collect ticks from selected soums of the provinces, identify tick species, species composition, distribution, tick densities, pathogens of tick-borne diseases, conduct population surveys to assess the risk of tick-borne infections, and identify tick-borne infections. Material and Method: Ticks were collected by flag from birch trees in birch forests and meadows with biotope and overgrown berries, determined morphological analyze and molecular biological investigation for detecting tickborne pathogens.
Questionnaires were collected from selected soum residents according to a specially designed randomized epidemiological and clinical survey card, collected information and forms were submitted to soum hospitals with a history of tick bites (according to clinical criteria). Serological tests were performed to detect IgG-specific antibodies to the collected serum mites. Result and conclusion Collected 121 ticks (120 I. persulcatus and 1 D. nuttalli) and not wound egg, larvae, nymphs. By molecular biological investigation detected 3.5% of I.persulcatus from Khutag-Undur soum of Bulgan province, 3.5% of anaplasmosis, and 14.1% of I.persulcatus mites from Bugat soum. 1.5% borreliosis, 3.1% anaplasmosis.
Detected DNA of 100% tick-borne rickettsiosis from D.nutalli ticks and determined circulation of infection among tick in Bugat and Khutag-Undur soums of Bulgan province.
247 people were surveyed, 56 blood serum from cases. Detected Q fever, erysipelas, and anaplasmosis, tick-borne borreliosis 3 (5.4%), tick-borne rickettsiosis 26 (46.4%), Japanese encephalitis 3 (5.4%), tick-borne encephalitis tick-borne rickettsiosis 6 (13.0%), tick-borne rickettsiosis tick-borne borreliosis 1 (1.8%), tick’s rickettsiosis Japanese encephalitis 1 (1.8%), tick-borne encephalitis tick-borne borreliosis 1 (1.8%).
By investigation, vaccination (88%) and wearing long-sleeved shirts and pants (81%) were the most effective ways to prevent tick bites (81%) [15]. According to our research, the percent of population knowledge in Bulgan province was insufficient (40.9%) which there is a lack of information, training and advertisement among the population in the province.

The microbiologist, who aged 44 man has work with glander DNA extraction between January and March at 2022, was developed sumptoms with fever, headache, muscle pain, weakness, cut throat, cough at 4 March, 2022. On March 7, he had tested Covid-19 and the result was negative. He was given 1gr tefazoline by eight-time interval for two days. Despite completing the therapy, episodes of fever and headache increased. A medical evaluation, which included MRI test was no disorder was developed. On March 12, painful with leg and developed muscle pain. He continued to difficulty to walk and cough, fever and weakness. On March 13, he has admitted hospital with diagnoses pneumonia.
He had continued sign with pneumonia in both lung, fever, infiltration with right leg, cough, headache, and glandule node in hospital. By PCR test, glander DNA was detected in sputum in National Center for Zoonotic Diseases laboratory. He recovered 20 days in hospital.
He has 12 days incubation period and infection route was by worked with glander strain and it was pneumonia form with laboratory-acquired human glanders.
Human glander case is rare in Mongolia. Three human glander cases had registered in 1966, 1972, 1977 among prison’s horse herder in Mongolia.