Trauma, systemic inflammatory response syndrome, dietary supplements, illicit steroid use and a questionable malignant hyperthermia reaction.

BACKGROUND: Malignant hyperthermia (MH) is a pharmacogenetic disorder of skeletal muscle calcium regulation associated primarily, but not exclusively, with mutations in the skeletal muscle ryanodine receptor. Associated environmental factors, however, may also be important for expression of the syndrome. METHODS AND RESULTS: A 24-yr-old trauma patient developed a fulminant MH crisis after a 3 minute exposure to sevoflurane. A thorough evaluation of underlying co-morbidities revealed a number of environmental factors that could have altered skeletal muscle calcium regulation, and may have potentially influenced the effects of volatile inhaled anesthetics. Since MH is a syndrome characterized by abnormal skeletal muscle calcium regulation, other factors that alter calcium homeostasis may exacerbate the impact of inhaled MH-triggering drugs. CONCLUSIONS: While a thorough history of MH episodes in a proband and family is emphasized as part of a complete preanesthetic evaluation, obtaining a history of other environmental entities that may alter calcium regulation may be equally important to knowing the family history.

Cases from the aerospace medicine residents' teaching file. Transient ischemic attack in an aviator with patent foramen ovale and Factor V Leiden.

A case report is presented of a naval aviator who suffered a transient ischemic attack (TIA) 1 mo after experiencing right leg pain and swelling following a 4-d drive. Although a venous thrombotic source was never discovered, the presence of both a patent foramen ovale and a thrombophilic condition supports paradoxical embolism (PDE) as the cause of this pilot's TIA. The presentation, diagnosis, treatment, and aeromedical disposition of TIA secondary to a PDE is discussed.