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: 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: 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.