Insight into Ping-Pong Gaze in the Neurosciences Intensive Care Unit

Excerpt

A 76-year-old, right-handed-woman presented with left-gaze deviation, right homonymous hemianopia, global aphasia, and right-sided hemiplegia with severe sensory loss. A computed tomography (CT) head scan head showed a dense left middle cerebral artery (MCA) stroke sign. Mechanical thrombectomy achieved recanalization of the left common carotid artery and MCA. She required intubation and did not recover after recanalization, showing no eye opening to pain and a combination of flexion and extension responses without clinical improvement. Repeat CT showed a maturing MCA territory infarct. The second day, she developed smooth side-to-side horizontal movements consistent with ping-pong gaze (PPG) or short-cycle periodic alternating gaze deviation (Supplementary video), as first described by Fisher in 1967 [1]. Magnetic resonance imaging (MRI) of the brain was performed to evaluate for additional infarcts given known bilateral hemispheric localization of PPG. An MRI revealed multiple territorial infarctions with large left MCA, bilateral occipital, and smaller right basal ganglia/capsulostriatal infarcts (Fig. 1).

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