Journal of Neurology

, Volume 265, Issue 12, pp 2825–2833 | Cite as

A closer look at ping-pong gaze: an observational study and literature review

  • Shi-Lin Yang
  • Xiang Han
  • Chun-Ni Guo
  • Xiao-Ying Zhu
  • Qiang DongEmail author
  • Yan WangEmail author
Original Communication



Little is known about ping-pong gaze (PPG) outside of individual case reports. We aimed to describe PPG through an observational study and literature review.


Consecutive patients with PPG at Shanghai General Hospital (SGH) from February 2016 to March 2018 were enrolled. A literature review through March 2018 was conducted.


Of the 14 patients with PPG in SGH, the median age was 60 years and 12 were males. The median Glasgow coma scale score was 7.5. The cycle of the PPG ranged from 1.5 to 6.5 s. The leading three etiologies were acute ischemic stroke in five patients, post-seizure state in three patients, and hypoxic-ischemic encephalopathy in two patients. A total of 88.9% (8/9) of the patients with consistent whole-field PPG had similar bilateral hemispheric damage, whereas 80.0% (4/5) of the patients with PPG in the hemifield had unilateral or extremely asymmetric bilateral hemispheric damage. The hemifiled side was the same side as the sole/dominant hemispheric lesion. The final clinical outcomes were neurologic remission for seven patients, vegetative state for one patient, and death for six patients.


PPG is a sign with localizing value that suggests hemispheric damage and asymmetric PPG might help to predict lateralization of the lesions. Acute ischemic stroke is the most common cause of PPG. Etiology and initial outcome are likely important prognostic factors of PPG.


Ping-pong gaze Hemispheric damage Conscious disturbance 



We thank Mr. Chong Li for the Fig. 1 painting.

Author contributions

SLY contributed to the study concept and design, collection and interpretation of data, and manuscript drafting. XH contributed to the collection and interpretation of data, manuscript drafting. CNG contributed to the collection and interpretation of data. XYZ contributed to the collection and interpretation of data. QD contributed to the study design, study supervision, and critical revision of the manuscript for intellectual content. YW contributed to the study design, study supervision, and critical revision of the manuscript for intellectual content. All authors read and approved the final manuscript.



Compliance with ethical standards

Conflicts of interest

The authors all declare no potential conflicts of interest.

Ethical approval

This study was approved by the Shanghai General Hospital Institutional Review Board. This study has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki. This study involved human participants.

Informed consent

Informed consent was obtained from the patients’ families.

Supplementary material

415_2018_9062_MOESM1_ESM.jpg (101 kb)
Figure e-1 (online only). Clinical outcomes of the 14 patients with PPG in the observational study. In the initial follow up (≤1 month), seven patients became awake, two patients remained in a vegetative state, and five patients died. The final clinical outcomes were neurologic remission with or without neurological deficit in seven patients, vegetative state in one patient, and death in six patients. (JPG 100 KB)
415_2018_9062_MOESM2_ESM.xlsx (13 kb)
Table e-1 (online only). Detailed information of 14 patients with ping-pong gaze in the observational study. (XLSX 12 KB)
415_2018_9062_MOESM3_ESM.xlsx (17 kb)
Table e-2 (online only). Data for 41 patients with ping-pong gaze reported in 30 publications (XLSX 16 KB)

Video 1 (online only). An example of ping-pong gaze in the whole field (case 1) (WMV 3241 KB)

Video 2 (online only). An example of ping-pong gaze in the hemifield (case 13) (WMV 3451 KB)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Neurology, Huashan HospitalFudan UniversityShanghaiPeople’s Republic of China
  2. 2.Department of Neurology, Shanghai General HospitalShanghai Jiao Tong University School of Medicine (originally Shanghai First People’s Hospital)ShanghaiPeople’s Republic of China

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