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: 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: 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: 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: Carotid artery stenting is increasingly being selected as the treatment for severe (≥70%) carotid artery stenosis, creating a growing need to prevent potential secondary complications associated with the procedure. In-stent restenosis (ISR) remains an important complication during long-term follow-up after carotid artery stenting. In this clinical case, we have addressed risk factors, pathogenesis, diagnosis, treatment, and monitoring of in-stent restenosis. Case Presentation: We describe the case of a 70-year-old man with severe, symptomatic IRS detected 1.8 years after carotid artery stenting (CAS). Conclusion IRS following carotid artery stenting is a clinically significant complication that may adversely affect cerebral perfusion and increase the risk of recurrent ischemic stroke. Early detection and follow-up with carotid duplex ultrasonography, regular follow-up, and lifestyle modifications, particularly smoking cessation, are essential for prevention of adverse cerebrovascular events.

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: 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.