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.

Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an immune-mediated polyneuropathy characterized by inflammation of the nerve roots and peripheral nerves, presenting with a slowly progressive onset and symmetrical sensorimotor involvement. CIDP affects males more than females, with a ratio of 2:1. Its overall prevalence varies from 0.7 to 10.3 per 100,000 people, and the incidence increases with advancing age.
The required criteria for CIDP include:
1) chronically progressive, stepwise, or recurrent symmetric proximal and distal weakness and sensory dysfunction in two or more limbs, developing over two months or longer (cranial nerves may also be affected);
2) absent or reduced tendon reflexes in all extremities. Diagnostic challenges can lead to misdiagnosis or overdiagnosis, emphasizing the need for prompt identification and treatment to prevent mortality and prolonged morbidity. Differential diagnoses for CIDP include Guillain-Barré syndrome, multifocal motor neuropathy, and hereditary neuropathy with liability to pressure palsies.
Treatment options for CIDP include corticosteroids (in this case: methylprednisolone, typically administered at 500 mg intravenously from the 9th day of treatment), intravenous immunoglobulin therapy, and plasmapheresis (plasma exchange). These treatments aim to halt the immune attack on the myelin of peripheral nerves, thereby reducing secondary axonal degeneration.
This case study pathophysiology, discusses CIDP’s clinical presentation, evaluation, diagnosis, and treatment. It underscores the vital role of the interprofessional team in providing comprehensive patient care, aiming to enrich healthcare professionals’ understanding. Staying updated on advancements and best practices enables professionals to optimize outcomes and enhance the quality of life for individuals grappling with this complex neurological disorder.

Introduction: According to the World Health Organization (WHO) in 2020, brain and central nervous system (CNS) cancers account for 2% of all newly diagnosed cancers in the world and 1.5% in Mongolia. Approximately 85-90% of all brain and other CNS tumors were diagnosed primary brain tumor. In 2019, the average 5 year survival probability was 50% for other cancers and 11% for the primary brain tumors. There were 28 patients with primary brain tumor and 33 relatively healthy individuals in our study. Goal: To study the diagnostic value of serum aquaporin-4 and glial fibrous acidic protein in the diagnosis of primary brain cancer Material and Methods: The Department of Neurosurgery at Third central hospital included 28 patients with primary brain cancer and 33 relatively healthy people. The study was conducted under the permission of the Medical Ethics Review Committee of the Ministry of Health on June 19, 2019 №119. Serum aquaporin-4 and glial fibrous acidic protein content was determined by the ELISA kits method using the human aquaporin-4 and glial fibrous acid protein test kit of the Chinese company “Sanlong”. The level is assumed to be true if the p value is less than 0.05. Results Mean age of the all participants was 42.9±16.5, 64% female and 36% male. Serum aquaporin-4 protein levels were 175.71±13.3 pg/ml and serum glial fibrilliary acidic protein levels were 2.682±0.218 ng/ml in patient with primary brain tumor. Serum aquaporin-4 protein and glial fibrilliary acidic protein levels were statistically significant high (p<0.001) in patient with primary brain tumor. Serum aquaporin-4 protein and glial fibrilliary acidic protein level differences were statistically significant (p<0.05) in benign and malignant tumor. There was no statistically significant correlation between serum aquaporin-4 and glial fibrillary acidic protein level and primary brain tumor grade.

Background: Globally the incidence of stroke is not decreasing, and the deaths and disabilities caused by stroke is increasing every year, especially in low and low-middle income countries.
Long-term trends in stroke incidence in different populations have not been well characterized, largely as a result of the complexities associated with population-based stroke surveillance.
Having reliable data on stroke morbidity and mortality, as well as periodic identification of long-term trends will be important information for proper prevention planning in the population, monitoring the disease and further improving the quality of health care. Material and Method: A prospective cohort study has been conducted in adult citizens (972409 in 2019, 925367 in 2020) of 6 districts of Ulaanbaatar from the 1st of January, 2019 to 31st of December, 2020. All first-ever and recurrent stroke cases were included using special software, developed for stroke registry, based on the WHO STEPS approach from participating radiology departments of state hospitals, district hospitals, and some private hospitals. Information of stroke death was obtained from forensic institute and state registration office of the capital city.
The trends of stroke incidence and mortality was compared to data between 1998-1999 and 2019- 2020 in UB. Results: The age-standardized crude incidence rate per 100.000 person-years of stroke were 209.0/100.000 (n=1934) in 2019 and 194.0/100.000 (n=1821) in 2020 among adults of UB city. The above results were compared to 1998-1999 studies and the incidence rate declined by 94.0/100.000 in 2019-2020, whereas mortality rate increased by 10.0/100.000 in women aged 16-34. Stroke mortality was 11.6% in 1998 and 26.5% in 1999, while in our study it was 33.87% in 2019 and 29.71% in 2020. Although the incidence of stroke rates has decreased in 1998-1999, the mortality rate has not decreased significantly. Conclusion Morbidity and mortality rates among the population of Ulaanbaatar citizen remain highest in the world, compared to 20 years ago with overall morbidity declining but mortality has not decreased.
In recent years, the Government of Mongolia has been focused on reducing non-communicable diseases, but the primary and secondary prevention and control of stroke in the general population, as well as the acquisition of knowledge attitudes, practices and access to health care still need to be improved.

Background: The incidence of acute SAH has been estimated at 2–22 cases per 100 000 persons per year. The most common cause of basal acute SAH is a ruptured cerebral aneurysm. Cerebral vasospasm in the first 2 weeks after aneurysmal subarachnoid hemorrhage is recognized as a major predictor of delayed cerebral ischemia. From 2014 through 2018, 5272 patients with a stroke (amongst them 20.4% were patients with aSAH) were hospitalized in the 3rd State Central Hospital of Mongolia. Objective: To study the clinical features of the cerebral vasospasm and dopplerosonography parameters in the aSAH patients. Materials and Methods: The methods, methodology and ethics of the research work were discussed at a Research meeting of Ethics Control Committee of the Mongolian National University of Medical Sciences held on December 22, 2017 (No2017 / 3-05), and the study was performed in accord with approval.
60 patients with aSAH (hospitalized from 2017 to 2018 year) were enrolled in the case-control study. Informed consent were obtained from each participants. Clinical condition of participants was classified by Hunt-Hess scale (HHS). Cerebral vasospasm degree was graded by Lindegaard index. Results: 52.5% of the participants were men and 47.5% were women. Average age was 49.9±12. When clinical condition degree was compared to vasospasm grade it was revealed that amongst 1st degree of Hunt-Hess scale (HHS) group 11.1% of enrolled patients’ spasm was normal or had no spasm, while it was observed either 44.4% mild and moderate spasm. In the 2nd degree of HHS group: normal in 6.9%, mild in 3.4%, moderate in 86.2%, and severe spasm was in 3.4%. In the 3rd degree of HHS group, 11.1% had no spasm, moderate spasm was in 77.8%, and severe spasm was in 11.1%. In 4th degree of HHS group, 71.4% were with moderate spasm, 28.6% were with severe spasm (p = 0.001).
When the Hunt-Hess Scale was compared to the Sinus Rectus 1st degree of Hunt-Hess scale (HHS) group Sinus Rectus was normal for 22.2% patients, mild for 66.7% and severe for 11.1%. Though 4th and 5th degree of Hunt-Hess scale (HHS) groups’ Sinus Rectus mild for 7.1% normal, 50.0% mild and 42.9% severe (p=0.007). Thus whenever the clinical condition worsened the cerebral intracranial pressure was increasing. Conclusion aSAH patients clinical complication degree were directly associated with the cerebral vasospasm revealed by the transcranial dopplerosonography. Therefore, the evaluation of Hunt-Hess scale has an important significance in the prevention from clinical complications and in the selection of the appropriate treatment approaches for aSAH patients.

Introduction : Attention-Deficit/Hyperactivity Disorder (ADHD) is a disorder that occurs during childhood development, which presents with signs of reduced attention and hyperactivity [1]. Necessary nutrients, such as trace minerals, including manganese, iron, zinc, iodine, selenium, copper, and chromium, are associated with changes in neuronal function that can lead to adverse effects on behavior and learning [2]. In addition to these, social, emotional, behavioral problems, and cognitive impairments such as executive dysfunctions are common in ADHD [3]. Goal: To evaluate the hair elements and intelligence quotient in children with ADHD. Materials and Methods: This is a cross-sectional comparative study conducted at elementary schools of Ulaanbaatar city. All in all 60 children of both genders aged between 7-12 years old were included in the study. Children were divided into two groups as children with ADHD group and a control group. Each group had 30 children. For assessment of emotional Intelligence EQ-i:YV - Emotional Quotient Inventory: Youth Version (Bar-On & Parker, 2000; it ad. Sannio Fancello, & Cianchetti, 2012) was used. Scalp hair samples were randomly collected from approximately ten sites around both sides of posterior parietal eminences and external occipital protuberance. Samples were then packed at room temperature and submitted for laboratory analysis. The study was approved by the Research Ethics Committee of Mongolian National University of Medical Sciences (Reg. No. 2018/Д-10). Results: The IQ of children with ADHD group were 85.03±16.86 p<.0001 and the IQ of control group =108.9±21.22, p<.0001. We identified hair minerals such as Mg, Zn, Pb, Se, Mn. We have then compared to each group and normal ranges of ages. ADHD group and the control group had Pb concentration that was slightly higher and inversely Mg concentration was slightly lower (r=-0.502, p=.005). Concentration of Pb, IQ were directly opposite (r=-0.38, p=.03). Conclusion
1. IQ was lower in the ADHD group compared to control group 85.03±16.86 p<.0001, monitored group 108.9±21.22, p<.0001.
2. The group with ADHD had lower Mg, Zn, and higher Pb, Se, Mn (p<.0001). The IQ decreased when there was increased Pb and decreased Mg.