Need Help With Patho

Published

So my study buddies and I are stumped by a couple of questions. I am hoping the answer is found through critical thinking that we are just too burnt out from taking path in eight weeks to realize it on our own.

The first question is:

When pressure in the brain is uneven what can result?

And the second question is:

What is a demyelinating disease where there is an abrupt onset of paralysis that remits spontaneously?

I think it is transverse myelitis but that was not mentioned in our lecture and only the text and so far there have been no answers just from the book...

Up Vote Up Vote ×
Specializes in ICU.

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.

Up Vote Up Vote ×
Specializes in Pedi.

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.

Up Vote Up Vote ×
Specializes in Cath Lab & Interventional Radiology.

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

Up Vote Up Vote ×
Specializes in ICU.
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

Up Vote Up Vote ×
Specializes in ICU.

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

Up Vote Up Vote ×
Specializes in Pedi.
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.

Up Vote Up Vote ×
Specializes in ICU.
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.

Up Vote Up Vote ×
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
So my study buddies and I are stumped by a couple of questions. I am hoping the answer is found through critical thinking that we are just too burnt out from taking path in eight weeks to realize it on our own.

The first question is:

When pressure in the brain is uneven what can result?

And the second question is:

What is a demyelinating disease where there is an abrupt onset of paralysis that remits spontaneously?

I think it is transverse myelitis but that was not mentioned in our lecture and only the text and so far there have been no answers just from the book...

When pressure in the brain is uneven what can result?

Not exactly a technically worked question is it? Where do they come up with this stuff?

OK....The answer can be found through critical thinking.

The brain in encased within an enclosed structure right? So....such that an increase in any of its contents; brain, blood, or CSF, will tend to increase the ICP (hypertension of the brain). In addition, any increase in one of the components must be at the expense of the other two; this relationship is known as the Monro-Kellie hypothesis. (http://www.ccri.edu/nursing/pdfs/2040eav-neuro1.pdf)

So if the brain, locked inside this enclosed structure, becomes injured by trauma or tumor on one side or another....what happens to the brain? It get shoved to one side or another or shoved down upon itself and the spinal cord therefore increasing the pressure inside the brain. Right?

The severely raised ICP, if caused by a one sided (unilateral) space-occupying lesion like a hematoma or tumor, can result in midline shift, a dangerous sequence of events in which the brain moves toward one side as the result of massive swelling in a cerebral hemisphere. Midline shift can compress the ventricles and lead to hydrocephalus therefore increasing the pressure inside the brain. Prognosis is much worse in patients with midline shift than in those without it.

The other issue of increased ICP combined with a space-occupying process is brain herniation (usually uncal or tonsillar). If brain stem compression is involved, it may lead to respiratory depression and is potentially fatal. This herniation is often referred to as "coning".

Major causes of death due to the raised intracranial pressure is global brain infarction as well as decreased respiratory drive due to brain herniation onto the brain stem....causing brain death.

http://www.aans.org/Patient Information/Conditions and treatments/Traumatic Brain Injury.a

The demyelinating disease the come to mind that comes and goes (relapsed and remits) as it pleases is MS.

Up Vote Up Vote ×
Specializes in Primary Care; Child Advocacy; Child Abuse; ED.

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:)

Up Vote Up Vote ×

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.

Up Vote Up Vote ×
+ Join the Discussion