Ping-pong gaze in combined intoxication with tranylcypromine, thioridazine, and clomipramine

Objective: This paper reports the occurrence of ping-pong gaze, a neuro-oph thalmological syndrome usually related to severe structural brain damage, i n a patient intoxicated with tranylcypromine, thioridazine, and clomipramin e. Background: Although there have been some reports about the occurence of Ping-pong gaze after intoxications. it is usually related to severe bilate ral hemispheric brain damage following stroke or traumatic injuries. Method : We report the case of a 56-year old woman who developed a neurotoxic synd rome with coma, hyperthermia, muscular rigidity, myoclonic jerks and tachyc ardia following an intoxication. Additionally rhythmic and pendular conjuga te horizontal eye movements could be observed for three days, so that the d iagnosis of ping-pong gaze was made. Results: A treatment with dantrolene l ead to complete remission of the neurotoxic syndrome with no signs of neuro logical or physical deficits. At the stage of regaining consciousness the e ve movements became normal. Conclusion: In our case the combined intoxicati on with an monoamine oxidase inhibitor, a neuroleptic and a tricyclic agent lead to a neurotoxic syndrome and the occurrence of a rare neuro-ophthalmo logical syndrome usually related to bilateral hemispheric brain dysfunction .