ABSTRACT
A 34 year old female presented with fever, diarrhoea, confusion, and a decline in mobility, having recently tested positive for COVID-19. Her medical history included patent foramen ovale, primary ovarian failure and leukoencephalopathy which had been investigated in her 20s leading to a clinical diagnosis of Vanishing White Matter disease (VWM). On admission she deteriorated rapidly with decreased GCS requiring frequent critical care review. MRI demonstrated mild progression of the cerebral atrophy and slight increase in the 'cystic' changes in the white matter. Lumbar puncture was unremarkable. EEG demonstrated widespread cerebral dysfunction with frontotemporal emphasis but without seizure activity. She was managed with supportive care recovering to her baseline function within days. VWM is a leukodystrophy caused by recessive mutations in eukaryotic initiation factor 2B (eIF2b) complex. Adult onset presentations have been described which have a slowly progressive course. Patients with VWM are known to rapidly decline with fever, and mild head injury occasionally resulting in coma. Our case high-lights the potentially devastating effects of a neurotropic virus such as COVID-19 in VWM, and the need to consider rare genetic disorders in adult patients presenting with extensive white matter abnormalities on MRI and premature ovarian failure.
ABSTRACT
Coronavirus disease (COVID-19) has increased stressors for couples related to unemployment, financial hardship, and interpersonal conflict (Luetke et al., 2020). Traditional models of care including relationship education programs need to adapt to meet the needs of couples in communication and conflict resolution during the pandemic. To this end, the aim of the current article is to highlight the transition of a face-to-face relationship education intervention to an online program, providing lessons learned focused on accessibility, modality, flexibility, engagement, and resources for maintaining cohesion and quality service delivery through the pandemic. (PsycInfo Database Record (c) 2021 APA, all rights reserved) © 2021 American Psychological Association