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Images in Neurology
November 2014

Ping-Pong GazeSherrington Would Not Have Done It Better

Author Affiliations
  • 1Department of Neurosciences, University Federico II, Naples, Italy
  • 2Sobell Department of Motor Neuroscience and Movement Disorders, University College London (UCL) Institute of Neurology, London, England
  • 3Dipartimento di Scienze Neurologiche e del Movimento, Università di Verona, Policlinico Borgo Roma, Verona, Italy
  • 4Center for Neurodegenerative Diseases (CEMAND), Neuroscience Section, Department of Medicine, University of Salerno, Salerno, Italy
  • 5Department of Motor Sciences, University Parthenope, Naples, Italy
JAMA Neurol. 2014;71(11):1450. doi:10.1001/jamaneurol.2014.1072

An 84-year-old man with an acute and progressive disorder of consciousness presented with ping-pong gaze1 (Video and Figure, A-C) and Cheyne-Stokes breathing, suggestive of metabolic or toxic cause. However, a midrange pupil not responsive to light indicated a lesion involving the brainstem. Metabolic or toxic causes were excluded by blood tests. At 6 hours from symptom onset, a computed tomographic scan showed a hypodense lesion in the midbrain tectum at the collicular level, suggestive of ischemic stroke (Figure, D). The patient died a few hours later, after the onset of decerebrate rigidity, according to Sherrington’s original description of cats with the brainstem’s collicular section.2

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