Need Help With Patho

When the pressure in the brain is uneven? What a terrible question. Is your teacher referring to intracranial pressure (which literally means, inside the cranium - not inside the brain - which is actually two different things). If the question is referencing ICP, then consider that the brain is buoyant (it floats) in CSF. Imagine a bathtub full of water with a rubber duck floating in the middle. If the water level in the bathtub drops, then so does the duck. If the water level in the bathtub rises, so does the duck. It's the same with the brain - except the brain is enclosed in a vault of solid bone (the skull). When ICP drops, vessels that surround the brain can tear and cause bleeding. When ICP is increased, the brain is pushed against the rigid walls of the skull, which can lead to bruising, tissue necrosis, and other serious problems. If ICP gets very very high, the brain can back up into the foramen magnum - the small opening at the base of the skull where the spinal cord enters.

As for the second question, Guillian Barre is also a demyelinating disease similar with regard to onset of paralysis that spontaneously resolves.

I worked in neurology/neurosurgery for 5 years and have no idea what your first question is even asking. If the pressure in the brain is "uneven"? Are they talking about ICP or CPP?

I have never seen transverse myelitis or Guillain Barre syndrome spontaneously remit but, then again, these patients wouldn't have to be admitted to the hospital if their disease resolved itself spontaneously.

I think the answer for the demyelinating disease question is Multiple sclerosis. It effects the myelin sheaths, and has flair ups and remissions.

I worked in neurology/neurosurgery for 5 years and have no idea what your first question is even asking. If the pressure in the brain is "uneven"? Are they talking about ICP or CPP?

I have never seen transverse myelitis or Guillain Barre syndrome spontaneously remit but, then again, these patients wouldn't have to be admitted to the hospital if their disease resolved itself spontaneously.

Guillian Barre is not cured in the hospital, because there is no cure. Patients with GBS are admitted to the hospital for symptom management and support because the symptoms can be life threatening. GBS does remit spontaneously - but if the progression and symptoms are severe enough, the patient may need to be supported in the process.

http://www.ncbi.nlm.nih.gov/pubmed/8500266

http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Guillain-Barre_syndrome

Guillain-Barre syndrome - PubMed Health

One more source. This one from the Louisiana Department of Health, pay special attention to the "Treatment" section:

http://new.dhh.louisiana.gov/assets/oph/Center-PHCH/Center-CH/infectious-epi/EpiManual/GuillainBarreManual.pdf

Guillian Barre is not cured in the hospital, because there is no cure. Patients with GBS are admitted to the hospital for symptom management and support because the symptoms can be life threatening. GBS does remit spontaneously - but if the progression and symptoms are severe enough, the patient may need to be supported in the process.

Spontaneous recovery from the Guil... [Clin Immunol Immunopathol. 1993] - PubMed - NCBIGuillain-Barre syndrome | Better Health Channel

Guillain-Barre syndrome - PubMed Health

The patients I'm thinking of always had to be treated with IVIG or plasma pheresis. Then again, they were in the hospital so they were the more severe cases, often with diaphragmatic involvement. I believe that it can remit spontaneously, I just said I've never seen it do so. The kids I saw with it typically ended up with prolonged ICU stays on vents and some left trach'd and G-tubed when they walked into the hospital with a little leg numbness. Fortunately, most of them went on to fully recover after prolonged inpatient rehab stays.

The patients I'm thinking of always had to be treated with IVIG or plasma pheresis. Then again, they were in the hospital so they were the more severe cases, often with diaphragmatic involvement. I believe that it can remit spontaneously, I just said I've never seen it do so. The kids I saw with it typically ended up with prolonged ICU stays on vents and some left trach'd and G-tubed when they walked into the hospital with a little leg numbness. Fortunately, most of them went on to fully recover after prolonged inpatient rehab stays.

The literature suggests that the disease remits in 80% of cases. Plasmapheresis and IVIG are not cures. Plasmapheresis flushes out the immune response by ridding the blood of antibodies and IVIG inactivates harmful antibodies. They only slow progression. The body will simply produce more harmful antibodies in response to its own neuronal tissue. Since GBS is a result of an auto-immune response, it cannot be cured, i.e., if you've seen any of your patients recover from GBS, it is because the disease spontaneously remitted...

Like I said, patients are admitted for life support because the symptoms are life-threatening. But neither the trach nor the G-tube cured any of your patients. Those things kept them from dying until the disease went into its natural remission.

I agree with MS for number two. That was a question we had last week and MS is what our professor taught us. Good luck:)

Thanks everyone for getting me thinking!

I have decided I am going with hydrocephalus for what is caused by uneven pressure in the brain. I think this article along with your responses would make it correct...

Demonstration of uneven distribution of intracra... [J Neurosurg. 2008] - PubMed - NCBI

I am going to go with MS for the second answer instead of GBS. Hopefully when it is on the test only one of those diseases will be given in the multiple choices or more information in the question.