[Slow, periodic alternating ping-pong gaze and Cheyne-Stokes respiration]

Area of Science:

• Neurology
• Ophthalmology
• Neuroscience

Background:

• Periodic alternating ping pong gaze (PAPPG) is an abnormal ocular movement often seen in comatose patients.
• PAPPG is typically associated with widespread bilateral hemispheric ischemia.
• Understanding the precise etiology and triggers of PAPPG is crucial for patient management.

Observation:

• A unique case of PAPPG is presented.
• The underlying lesion was initially unilateral, later becoming bilateral.
• PAPPG episodes were intermittent and coincided with Cheyne-Stokes respiration.

Findings:

• The initial unilateral lesion leading to PAPPG challenges the assumption of strictly bilateral hemispheric damage.
• The association with Cheyne-Stokes respiration suggests a potential link between respiratory patterns and PAPPG.
• Intermittent PAPPG presentation indicates variability in the manifestation of this ocular motor abnormality.

Implications:

• This case necessitates a reconsideration of the pathophysiological mechanisms underlying PAPPG.
• The findings may refine diagnostic approaches for coma patients with abnormal ocular movements.
• Further research is warranted to explore the relationship between respiratory control and PAPPG.