Sternal Gap Syndrome Caused by Improperly Fitted Body Armor: A Preventable Military Injury.

Isolated atrophy of the pectoralis major muscle (PMM) secondary to traumatic lesion of the medial pectoral nerve is a known entity in the field of neuromuscular electrodiagnostics. Recent literature has begun describing a Pectoral Gap Phenomenon in which this atrophy occurs bilaterally as an overuse injury, leading to a marked concavity in the central chest wall musculature. While there is limited information in science journals on this topic, social media posts on weight lifting discuss the topic frequently. We report a case in which a soldier's body armor crushed the lateral medial and pectoral nerves against the anterior chest wall causing permanent upper body weakness. To optimize military medical readiness, awareness of this disorder and the pathophysiology causing it should spread so as to mitigate this potential for significant disability.

Status epilepticus after C-4 ingestion: using liquid chromatography to quantify toxicity.

Context: C-4, a commonly used explosive in military operations, is sometimes consumed by soldiers as a rite of passage. The primary component of C-4 is cyclotrimethylenetrinitramine, or Research Department Explosive (RDX), which causes euphoria along with nausea, vomiting, renal injury, encephalopathy and convulsions when consumed in toxic amounts. We present a case of status epilepticus caused by known ingestion of C-4, in which serum levels of the compound were measured with high-performance liquid chromatography (HPLC). Case details: A 22-year-old active-duty male with no prior medical history was brought to the ED with convulsions that only minimally improved traditional anti-epileptic treatment. EEG showed persistent epileptiform activity despite initial management. Continuous propofol infusion, lacosamide and levitiracetam eventually broke the seizures. The patient eventually reported consuming a piece of C-4 four hours prior to the start of his seizure activity. Results: HPLC showed a peak RDX concentration of 3.06 µg/ml. RDX concentration at cessation of seizure activity was 2.43 µg/ml. Conclusion: Per our review of the literature, this is the first case where the explosive's toxicity could directly be measured over time in a human patient. C-4 poisoning must be considered when assessing sudden onset epileptiform activity in soldiers with access to this substance.

Magnetic resonance spectroscopic findings in neuro-Behçet disease.

BACKGROUND: Behçet disease is a heterogeneous, multisystem disorder with elements of both environmental and autoimmune pathologic processes. Neuro-Behçet, found in 10%-25% of Behçet patients, has been characterized as a vasculitis primarily affecting the brain stem. On magnetic resonance imaging, some cases demonstrate extension to the bilateral cerebral cortices and/or the spinal cord, often with a degree of mass effect. Content of this paper provides a case study, along with review of the literature regarding this disease entity, and proceeds to outline the appearance of neuro-Behçet on magnetic resonance spectroscopy. CONCLUSION: In essence, a drop in the N-acetyl aspartate peak indicative of axonal loss in concert with elevations in lipid myoinositol and choline/creatine ratios (nonspecific markers of myelin breakdown) is found, indicating that a possible demyelinating process is complexed with the vasculitic pathology neuro-Behçet is traditionally ascribed to.