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: Differentiating brain abscesses from necrotic cystic tumors is critical for clinical management but remains challenging due to overlapping features on conventional MRI. Aim: To evaluate the diagnostic performance of diffusion-weighted and morphological MRI biomarkers in differentiating brain abscesses from necrotic cystic brain tumors. Materials and Methods: This retrospective study included 54 patients with ring-enhancing brain lesions (brain abscess, n=13; metastasis, n=18; glioblastoma, n=23). MRI protocols (T1W, T2W, DWI, SWI, and T1+CE) were analyzed for lesion morphology, diffusion characteristics, capsule thickness, and the “dual rim sign.” Group comparisons were performed using ANOVA, chi-square, and Fisher’s exact tests. Diagnostic performance and optimal thresholds were determined using ROC curve analysis (p<0.05). Results: 1. Comparison of Diffusion Parameters: The core ADC ratio min was significantly lower in the brain abscess group than in the cystic-necrotic tumor group (0.812±0.228 vs 1.902±0.535 for glioblastoma, 1.590±0.394 for metastasis; p<0.001). The area under the curve (AUC) for core ADC ratio min was 0.977, indicating excellent diagnostic performance. 2. Capsule Characteristics: On SWI, the “dual rim sign” was detected in 92.3% of brain abscesses but was absent (0%) in all cystic-necrotic tumors (p<0.001). The abscess capsules were significantly thinner (mean 3.3 mm) and more uniform compared to the irregular, thicker walls of necrotic tumors. 3. Diagnostic Thresholds: The optimal cut-off value for the core ADC ratio min was 0.94 (sensitivity 92.3%, specificity 92.7%). For capsule thickness, the cut-off value was 3.3 mm with an AUC of 0.955. Conclusion Core ADC ratio and capsule thickness are reliable quantitative MRI biomarkers for differentiating brain abscesses from cystic-necrotic tumors. Integrating diffusion metrics with susceptibility-based and morphological features, such as the “dual rim sign,” significantly enhances diagnostic accuracy in clinical practice, facilitating non-invasive and timely diagnosis.

Background: Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder associated with cognitive impairment and structural brain alterations. White matter hyperintensities (WMH) detected on magnetic resonance imaging (MRI) serve as critical neuroimaging markers of cerebral small vessel disease. However, research evaluating the WMH burden in the Mongolian population with T2DM using AI-based automated quantitative methods and comparing these findings with a control group remains limited. This research gap provides the rationale and necessity for the current study. Aim: To evaluate and compare the burden of brain white matter hyperintensities (WMH) in adults with type 2 diabetes mellitus (T2DM) versus a control group. Material and Methods: This analytical cross-sectional, retrospective comparative study included participants aged 40 and older who underwent brain MRI at the Mongolia-Japan Hospital of MNUMS between 2019 and 2025. The T2DM group consisted of patients with a confirmed diagnosis, while the control group included individuals without diabetes or prediabetes. After excluding cases with major structural abnormalities, poor image quality, failed automated processing, or incomplete clinical data, 257 out of an initial 283 participants were included in the final analysis (T2DM: 71, Control: 186). 3D T1-weighted MPRAGE and T2-FLAIR MRI sequences were processed using Neurophet AQUA software (version 3.1) to assess total, deep, and periventricular Fazekas scores. Age- and sex-adjusted ordinal logistic regression analysis was performed using SPSS 25.0, with p<0.05 considered statistically significant. Results: A total of 257 participants (T2DM=71, Control=186) were analyzed. There were significant differences between groups in sex distribution (p=0.046) and age categories (p<0.001). The T2DM group exhibited significantly higher total and deep Fazekas scores compared to the control group (total Fazekas: aOR 10.81, 95% CI 5.20-22.49; deep Fazekas: aOR 8.21, 95% CI 4.32-15.60; both p<0.001). Increasing age was associated with higher total (aOR 1.07, 95% CI 1.03-1.11, p=0.001) and deep (aOR 1.04, 95% CI 1.00-1.08, p=0.037) Fazekas scores. Additionally, female sex was associated with higher total (aOR 1.95, 95% CI 1.04–3.63, p=0.036) and deep (aOR 1.95, 95% CI 1.08–3.51, p=0.026) Fazekas score categories. Conclusion Assessment of WMH burden using AI-based automated quantitative MRI processing revealed that T2DM is significantly associated with higher total and deep Fazekas scores. This association remained significant after adjusting for age and sex. These findings suggest that AI-based MRI processing is a suitable method for the objective, quantitative, and standardized assessment of brain WMH burden associated with T2DM.

Background: The Global Cortical Atrophy (GCA) scale is widely used for visual assessment of cortical atrophy on MRI but is subject to interobserver variability. Automated brain volumetry provides objective measurements; however, its association with visual atrophy grading remains understudied in Mongolia. Aim: To assess the association and agreement between radiology report–based atrophy grades and AI-derived whole-brain volume, and to compare brain volumes in adults with and without type 2 diabetes mellitus (T2DM). Materials and Methods: This retrospective, single-center study included 367 adults aged ≥40 years (T2DM, n=144; controls, n=223). Intracranial volume–adjusted whole-brain volumes were obtained from 3D T1-weighted MRI using Neurophet AQUA v3.1. Atrophy severity recorded in routine radiology reports was coded from 0 to 3. Welch’s ANOVA assessed differences across grades, and ROC analysis evaluated discrimination between adjacent grades. Classification agreement was assessed using stratified five-fold cross-validation and Cohen’s κ. Age- and sex-adjusted ANCOVA compared brain volumes between groups. Results: Mean whole-brain volume decreased across atrophy grades 0–3 (1122.12, 1068.50, 1034.76, and 968.33 mL; Welch’s F(3, 60.04)=207.30; P<0.001). ROC AUCs for adjacent grades were 0.892, 0.897, and 1.000, with corresponding thresholds of 1099.86, 1056.17, and 995.57 mL. Five-fold cross-validation yielded 78.7% exact agreement (289/367), unweighted κ=0.684, and quadratic-weighted κ=0.856. Adjusted whole-brain volume was 11.98 mL lower in T2DM than in controls (95% CI, −22.67 to −1.30; P=0.028), whereas the overall association between T2DM and atrophy grade was not statistically significant (P=0.059). Conclusion Higher report-based atrophy grades were associated with lower whole-brain volumes, with strong quadratic-weighted agreement between volumetric and report-based classifications. Adults with T2DM had lower adjusted brain volumes than controls. Automated volumetry may complement radiologists’ assessments by providing objective quantitative information.

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: 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: One-third of people with epilepsy have drug-resistant epilepsy, making surgical treatment necessary. Comprehensive pre-surgical evaluations, including long-term video-electroencephalographic (VEEG) monitoring, magnetic resonance imaging (MRI), and neuropsychological testing, are essential components of epilepsy presurgical evaluation. The Epilepsy Center at the Mongolian-Japanese Hospital of MNUMS was established in September 2022 and introduced long-term video-EEG monitoring in May 2023. This marked the first time in Mongolia that comprehensive evaluation for epilepsy surgery became available. Aim: To evaluate the role and outcomes of long-term video-EEG monitoring in the pre-surgical assessment of epilepsy patients Materials and Methods: A prospective cohort study was conducted at the Epilepsy Center of the Mongolian-Japanese Hospital from May 2023 to March 2025. Patients who underwent VEEG and comprehensive pre-surgical evaluation were included. Data included demographic information, seizure history, imaging findings, and neurophysiological assessments (routine, sleep-deprived, and long-term video EEG). Patients were divided into two groups based on whether they met criteria for epilepsy surgery, and surgical outcomes were compared between these groups. Results: A total of 297 patients (104 children and 193 adults) participated in the study. Of these, 96 (32%) were diagnosed with temporal lobe epilepsy and underwent pre-surgical evaluation. The mean age of this group was 33±9.2 years; male-to-female ratio was 1:1. Age of seizure onset was 20±10.9 years, and the mean duration of epilepsy was 14.8±10.3 years. Etiologies included meningitis (21.7%), febrile seizures (15.2%), birth complications (12.5%), and traumatic brain injury (12.5%). The average duration of VEEG monitoring was 1.45±0.68 days, during which 161 seizures were recorded (average 2.64 per patient). No seizures were captured in 35 patients. Among the 96 patients, 29 met the criteria for surgical intervention, and 11 underwent temporal lobe epilepsy surgery. Surgical outcomes were significantly better compared to the non-surgical group (p<0.05). Conclusion Long-term video-EEG monitoring plays a critical role in precisely localizing the epileptogenic zone, identifying seizure types, establishing differential diagnoses, and optimizing surgical candidacy. It is confirmed as an essential diagnostic tool in the pre-surgical evaluation for epilepsy surgery.

Background: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disorder characterized by degeneration of upper and lower motor neurons, leading to muscle weakness, spasticity, dysarthria, and dysphagia. Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an autoimmune-mediated neuropathy that primarily affects nerve fibers specifically myelin sheets. Clinically, CIDP presents with distal muscle weakness, prominent sensory disturbances, and diminished or absent deep tendon reflexes. The co-occurrence of ALS and CIDP is exceptionally rare and poses significant diagnostic and therapeutic challenges due to overlapping and distinct clinical features. A Case: A 44-year-old male presented to the Department of Neurology at the Mongolia-Japan Hospital, Mongolian National University of Medical Sciences, with progressive muscle weakness in both upper and lower extremities, along with dysphagia, especially for solids with frequent choking episodes. The initial symptoms began in May 2023 with muscle fasciculations, followed by progressive weakness, initially in the right upper limb and gradually progressing to the left. By August 2023, the patient developed bilateral arm weakness, dysarthria, and worsening dysphagia. From August 2024, episodes of head drop were noted. A progressive weight loss of 11 kg was recorded since January 2024. Comprehensive neurological evaluation, including antibody profiling, electromyography (EMG), and nerve conduction studies (NCS), supported a diagnosis of amyotrophic lateral sclerosis with chronic inflammatory demyelinating polyradiculoneuropathy-like neuropathy. Outcome: One month after hospital discharge, the patient demonstrated improvement in self-care abilities and increased muscle strength in both proximal and distal upper limb muscles. Notably, there was marked improvement in overall clinical status. Conclusion To our knowledge, this is the first reported case in Mongolia documenting the simultaneous presentation of ALS and CIDP-like neuropathy. Globally, such cases are exceedingly rare. Timely and accurate diagnosis, along with appropriate treatment, contributed to improved clinical outcomes and a deceleration of disease progression in this patient.

Background: Sleep quality is frequently highlighted in the literature as a key factor for overall health. Poor sleep quality significantly affects both physical and mental health, diminishing quality of life and potentially harming personal finances. While this issue is influenced by various risk factors, no well-studied research has been conducted on it in Mongolia. Aim: The aim of this study was to assess the frequency of poor sleep quality among visitors to the Sleep center in Mongolia and to identify the factors associated with poor sleep quality. Materials and Methods: This study, conducted using a cross-sectional design, included 200 participants aged 18 to 65 years who visited the Sleep Center at the General Hospital for State Special Servants between January and May 2024. Data were collected using a structured questionnaire. Sleep quality was assessed using the Mongolian version of the Pittsburgh Sleep Quality Index, with a global score above 6 indicating poor sleep. Participants were divided into two groups: “Good sleepers” (n=105) and “Poor sleepers” (n=95). Socio-demographic and clinical variables such as age, sex, levels of education were also recorded. The level of depression, anxiety, and stress was assessed using the DASS 21 (Depression Anxiety Stress Scale) criteria. Univariate analysis was performed using the t-test, Mann-Whitney U test for continuous data, the Х2 or Fishers’s exact test for categorical data, and logistic regression for multivariable analysis. A P-value of less than or equal to 0.05 was considered significant. Results: Poor sleep quality, indicated by a PSQI global score above 6, was observed in 52.5% of the total participants. Univariate analtysis’s test results showed that age, being female, having depression, anxiety, BMI ≥ 25, alcoholism, comorbidities, and using concomitant medications were significantly associated with poor sleep quality (all p<0.05). In the multivariate logistic regression analysis, 50 < age (OR 3.133, 95% CI, 1.245-7.884, p<0.05), BMI ≥ 25 (OR 2.084, 1.039-4.179, p<0.05), alcoholism (OR 3.018, 95% CI, 1.495-6.093, p<0.01) and depression (OR 15.957, 95% CI, 1.592-159.922, p<0.05) were identified as significant risk factors for poor sleep quality. Depression and alcoholism were associated with longer sleep latency and decreased daytime activity (p<0.05). Conclusions 1. In our study, more than half of the participants experienced poor sleep quality. 2. Age over fifty, depression, BMI ≥ 25, and alcoholism emerged as independent significant risk factors for sleep disturbance. Alterations in sleep latency, sleep disruption, and impaired daytime functioning may be associated with poor sleep quality.

Background: Memory is a complex combination of the activities of fixation, keeping and recalling information, which is manifested by quantitative and qualitative changes due to organic mental disorders. Epilepsy is a disorder with neurological and mental symptoms, and depending on the course of the disease, adherence to medication regimen, and the frequency of seizures, memory can decrease leading to partial or complete dementia. Therefore, we conduct this study by Luria A.Ya’s assessment evaluating memory’s changes, such as mechanic memory. Aim: The aim of the study is to evaluate the memory changes in patients with epilepsy using standart questionnaire. Materials and Methods: The study was a hospital-based, descriptive, cross-sectional design, using a questionnaire survey method, and using a standard 10-word memorizing test. The study was conducted in NCMH from 1st of July to 1st of August of 2023 and ethical approval for this study was approved by the NCMH (3/603 14th of June, 2023) and Research Ethics Review Committee of MNUMS (2023/3-08 16th of June 2023). Collected data statistics were created by graphics and tables on Microsoft Word and Microsoft Excel programs and were analyzed in SPSS 21.0 software. Results: The study included 30 patients, 19 (62.5%) men and 11 (36.3%) women, aged 25-59, with a disease duration of 4-59 years. In 60% of cases cause of the disease was brain injury, n=18 had less than secondary education, and n=26 (86.6%) had defined with disability. 73.2% of the study participants fell 2-3 times a week, 73.3% did not take medication as prescribed, and 56.7% did not follow the medication regimen. The results of the 10-word memorizing test showed that 1-9 words were said more often in each repetition, with an average value of 3.2-3.9 for each repetition, and the frequency of the extra words was 0.8. When examining whether the word memorizing test scores depended on the duration of the illness, the number of words recalled by patients with illness lasting up to 59 years was 1-3, indicating that the longer the illness lasted, the lower memory. Conclusion 73.3% of patients do not take medications as prescribed by their doctor (p=0.35), 56.7% do not follow the medication regimen, the average value of the mechanical memory test is 3.2-3.9, and the results show that memory decreases with the duration of the disease, indicating that there are many reasons for the decrease in patients’ memory.