Ping-pong gaze and ocular nodding in bacterial meningitis

A 27-year-old man presented with fever, somnolence, seizure, and nuchal rigidity. CSF culture indicated Streptococcus pneumoniae, confirming the diagnosis of bacterial meningitis. Ping-pong gaze was observed initially, and then replaced by what we called ocular nodding after IV administration of diazepam (video at Neurology.org). The eyes went downward and returned to primary position slowly, smoothly, and periodically (with a cycle lasting 12–17 seconds and a pause between 2 cycles), resembling a nodding head. He became alert with free eye movement within 3 days of antibiotic treatment. Ping-pong gaze has been reported,1 but ocular nodding is a novel finding.

Source: Neurology - November 6, 2017 Category: Neurology Authors: Wang, Y., Huang, Y.-H., Yang, S.-L. Tags: Meningitis, Clinical neurology examination, Ocular motility VIDEO NEUROIMAGES Source Type: research