Ping-pong gaze in combined intoxication with tranylcypromine, thioridazine, and clomipramine.
OBJECTIVE
This paper reports the occurrence of ping-pong gaze, a neuro-ophthalmological syndrome usually related to severe structural brain damage, in a patient intoxicated with tranylcypromine, thioridazine, and clomipramine.


BACKGROUND
Although there have been some reports about the occurence of Ping-pong gaze after intoxications, it is usually related to severe bilateral hemispheric brain damage following stroke or traumatic injuries.


METHODS
We report the case of a 56-year old woman who developed a neurotoxic syndrome with coma, hyperthermia, muscular rigidity, myoclonic jerks and tachycardia following an intoxication. Additionally rhythmic and pendular conjugate horizontal eye movements could be observed for three days, so that the diagnosis of ping-pong gaze was made.


RESULTS
A treatment with dantrolene lead to complete remission of the neurotoxic syndrome with no signs of neurological or physical deficits. At the stage of regaining consciousness the eye movements became normal.


CONCLUSIONS
In our case the combined intoxication with an monoamine oxidase inhibitor, a neuroleptic and a tricyclic agent lead to a neurotoxic syndrome and the occurrence of a rare neuro-ophthalmological syndrome usually related to bilateral hemispheric brain dysfunction.
Prueter
C
C
Department of Psychiatry and Psychotherapy of the Technical University (RWTH), Aachen, Germany. Christian.Prueter@post.rwth-aachen.de
Schiefer
J
J
Norra
C
C
Podoll
K
K
Sass
H
H
D000929:Antidepressive Agents, Tricyclic / Q000506:poisoning*; D014150:Antipsychotic Agents / Q000506:poisoning*; D002997:Clomipramine / Q000506:poisoning*; D003620:Dantrolene / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008875:Middle Aged; D008996:Monoamine Oxidase Inhibitors / Q000506:poisoning*; D009125:Muscle Relaxants, Central / Q000627:therapeutic use; D020258:Neurotoxicity Syndromes / Q000188:drug therapy / Q000209:etiology*; D015835:Ocular Motility Disorders / Q000139:chemically induced* / Q000188:drug therapy; D013881:Thioridazine / Q000506:poisoning*; D014191:Tranylcypromine / Q000506:poisoning*
D000929:Antidepressive Agents, Tricyclic; D014150:Antipsychotic Agents; D008996:Monoamine Oxidase Inhibitors; D009125:Muscle Relaxants, Central; D014191:Tranylcypromine; D003620:Dantrolene; D013881:Thioridazine; D002997:Clomipramine