Autonomic neuropathy in systemic lupus erythematosus.

Sir: The term Ping Pong gaze was first used by Senelick in 1976' to describe the periodic alternating gaze of an unconscious patient. There are now six cases reported in the literature'" which manifested this disorder of rhythmic and pendular conjugate horizontal deviation, which alternates from one extreme of gaze to the other, with a cycle time of between three and seven seconds duration. Five of the six cases described have been in coma. These cases have all had structural brain damage, generally affecting both hemispheres and have all died. In contrast, the patient reported by von Cramon and Zihl,4 who had suffered multiple bilateral infarcts and showed periodic alternating gaze for several months, retained conscious-

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