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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
Moccia M, Allocca R, Erro R, Barone P, Vitale C. Ping-Pong Gaze: Sherrington Would Not Have Done It Better. JAMA Neurol. 2014;71(11):1450. doi:10.1001/jamaneurol.2014.1072
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