Rare Stroke Symptom Appears in Awake Patients
A recent case report identifies ping-pong gaze as a sign of an artery of Percheron stroke in awake individuals.
Updated on Oct. 16, 2026 in Stroke
A medical case report from February 2026 describes a 70-year-old man who presented with ping-pong gaze while awake, an eye movement pattern previously associated only with comatose patients. Clinicians discovered the patient had suffered a rare stroke involving the artery of Percheron, an anatomical variant supplying both sides of the thalamus.
Why it matters
This case highlights the importance of recognizing atypical symptoms during neurological emergencies. Because initial CT scans can appear normal in stroke cases, identifying rare clinical signs like ping-pong gaze can help clinicians pinpoint localized damage in the thalamus or midbrain more quickly.
A case report published in February 2026 documented a single instance of ping-pong gaze in an awake patient, contrasting with its traditional clinical classification as a sign of coma. While the report illustrates this rare presentation, the physiological thresholds for the gaze remain unresolved.
The players
Md. Deluwar Hussen
A researcher who published the case study detailing this unusual presentation of stroke.
Zareen Tabassum
A researcher who co-authored the 2026 report on the rare artery of Percheron stroke.
C. Miller Fisher
A neurologist who provided the foundational description of ping-pong gaze in 1967.
The details
The artery of Percheron is an anatomical variation where a single vessel branches off the posterior cerebral artery to supply both sides of the thalamus and parts of the midbrain. A blockage in this vessel results in bilateral damage, which can disrupt neural pathways responsible for coordinating eye movements. When the brainstem and thalamic regions are affected by this specific stroke, it can manifest as the slow, side-to-side oscillations known as ping-pong gaze.
Timeline
1967: C. Miller Fisher first described ping-pong gaze.
2023: Frontiers in Neurology published a case report on gaze.
February 2026: Radiology Case Reports published the 70-year-old patient case.
August 2026: Langenbeck's Archives of Surgery published a narrative review.
Health Landscape
This finding updates the historical diagnostic consensus established by C. Miller Fisher in 1967, which previously linked ping-pong gaze exclusively to comatose patients. By documenting the sign in an awake individual, this case expands the criteria used by neurologists to identify thalamic strokes.
This report reinforces the value of clear communication regarding sudden changes in eye movement or coordination during a medical emergency. If you or a loved one experience unexplained neurological symptoms, such as difficulty focusing or abnormal eye movements, seek immediate emergency care.
The takeaway
Recognizing rare clinical signs can be critical in detecting strokes that may not initially show on standard diagnostic imaging. Discuss any persistent or sudden neurological symptoms, including unusual eye movements, with a medical professional immediately to ensure appropriate evaluation.
Further reading
For more information on the diagnostic signs and management of neurological events, visit Stroke.
Source note: This article includes information reported by Medical Daily.
