“Ping‑pong gaze” secondary to monoamine oxidase inhibitor overdose

Attaway, Amy; Sroujieh, Laila; Mersfelder, Tracey L.; Butler, Christopher; Ouellette, Daniel

doi:10.4103/0976-500X.179360

Case ReportArchivesVol. 7 | Issue 1 | 2016 | pp. 34–37Open Access

“Ping‑pong gaze” secondary to monoamine oxidase inhibitor overdose

¹^*,
²,
³,
⁴,
⁴

¹Department of Pulmonary Critical Care, University Hospitals, Case Western Reserve University, Cleveland, Ohio, USA.
²Department of Pulmonary Critical Care, MetroHealth Medical Center, Cleveland, Ohio, University Hospitals, Case Western Reserve University, Cleveland, Ohio, USA.
³Department of Pharmacy, Ferris State University, Borgess Hospital, Kalamazoo, Michigan, USA.
⁴Pulmonary Critical Care, Henry Ford Health System, Detroit, USA.

Correspondence: Amy Attaway
Department of Pulmonary Critical Care, University Hospitals, Case Western Reserve University, Cleveland, Ohio, USA.
Email: amy.attaway@uhhospitals.org

Published: Jan 1, 2016, Received: Jan 23, 2015, Accepted: Jun 12, 2015

DOI: https://doi.org/10.4103/0976-500X.179360
Article URL: https://www.jpharmacol.com/article/j-pharmacol-pharmacother-7-1-34
PDF URL: https://www.jpharmacol.com/article/j-pharmacol-pharmacother-7-1-34.pdf

Abstract

An infrequent manifestation of monoamine oxidase inhibitor (MAOI) toxicity is “ping-pong gaze” (PPG). We describe the case of a 26-year-old female who was found unresponsive after taking 40 tablets of phenelzine. On presentation to the hospital, her eyes were moving in characteristic “ping pong” fashion. After 6 hours her gaze terminated. The following day her neurologic exam was benign and she had no long-term sequelae. While the etiology of PPG is unknown, it is most often seen with irreversible structural brain damage. However, a detailed literature review revealed that previous cases of MAOI toxicity where the patient survived have all had complete neurologic recovery.

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