Abstract
Background Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a neuroinflammatory disorder with a predilection for females. Males present differently, with seizures rather than the better-recognized constellation of psychiatric and behavioral symptoms dominating the initial stages of the disease, providing a potential substrate for delayed recognition and treatment. Case Presentation An 18-year-old man presented with fever and “seizures. When examined, he was febrile but alert and coherent. His neurologic, respiratory, cardiovascular, and abdominal examinations were unremarkable. Diagnosed with infective meningoencephalitis, he was started on intravenous ceftriaxone and acyclovir concurrently with anti-epileptic medications. However, he deteriorated into refractory status epilepticus. Electroencephalograms showed left temporo-parietal seizures. Cerebrospinal fluid analysis revealed inflammatory features, but the virologic assays and bacterial cultures returned negative. Magnetic resonance imaging scans performed in the first and second week from symptom-onset demonstrated the interval development of widespread sulcal T2 hyperintensity, with florid and diffuse leptomeningeal enhancement. Anti-NMDAR antibodies were subsequently detected in his cerebrospinal fluid by indirect immunofluorescence. Diagnosed with anti-NMDAR encephalitis, he received plasmapheresis, methylprednisolone and immunoglobulin infusions. Conclusion Anti-NMDAR encephalitis should be considered in patients, especially males, who are treated for suspected infectious meningoencephalitis, but continue to deteriorate, even in the absence of prominent psychiatric or behavioral symptoms, considering how the initial symptoms differ between the genders. The interval development of diffuse and florid leptomeningeal enhancement on sequential magnetic resonance imaging scans of our patient has not been described in prior reports, and may be reflective of the underlying inflammatory processes.
Highlights
Adopted children and their families have unique needs compared to non-adoptive families
The measures include quantitative and qualitative date completed by eleven parents who participated in the summer 2019 Learning and Empowerment for Adoptive Families (LEAF)
While LEAF ran with a group of eleven participants, three measures were discarded because the respondents did not complete all of the questions
Summary
Adopted children and their families have unique needs compared to non-adoptive families. Adoption research seeks to understand these unique needs and contribute to a growing field of adoption competent therapy. The purpose of this paper is to understand how adoption competent group therapy can benefit adoptive families, and provides analysis on secondary data collected in 2019 from pre and post measures for a weekly support group from post-adoption program. Current data reveals that in the United States around 7 million people are adopted, and around 140,000 children are adopted each year (Adoption Facts, 2013). 100 million people have a family connection with adoption in the United States, whether someone is adopted within their family, or they were adopted themselves (Adoption Facts, 2013). This paper seeks to understand the effectiveness of adoption competent therapy, and identify ways it can help families
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