Vladimir Putin has been seen gripping the table, slouching and repeatedly tapping his foot - prompting rumours that he has Parkinson's.
The bloated Russian President looked "feeble and barely able to hold himself upright" as he gave orders in relation to the invasion of Mariupol.
He looked distracted and in pain as he told Sergei Shoigu to obstruct the Azovstal steelworks “so that not even a fly can escape”.
Up to 2,000 soldiers and civilians including children have sought refuge at the plant which has a series of underground tunnels and basements.
Western intelligence believes Putin is not a well man amid widespread speculation that he was suffering a serious illness when he launched the war in Ukraine.
Parkinson's is the latest theory following another that he was battling cancer with a specialist in thyroid cancer among the elderly at his beck and call.
Putin did not perform his usual bravado in his latest appearance which was one of the most shocking episodes to date.
A video which captured the event showed the aged Kremlin leader sunk into his chair and tapping both his feet throughout the 12--minute meeting.
He appeared with a bloated face and held onto the corner of the table the entire time with his thumb twitching on top.
However, Russian officials have denied there is anything wrong with Putin who will celebrate his 70th birthday in October.
A body language expert explained that an able-bodied president "would not need to keep himself propped up with a hand held out for leverage" and "both feet planted on the ground."
Professor Erik Bucy, from Texas Tech University, told the Sun Online : "It’s an astonishingly weakened Putin compared to the man we observed even a few years ago.
"This is not a portrait of a healthy Putin but one appearing increasingly feeble and barely able to hold himself upright at a small conference table."
Prof Bucy compared the appearance to Richard Nixon's weak demeanour during a presidential debate against JFK in 1960 when he was recovering from a knee injury.
The expert also picked up on Putin's "quite thin" legs and "bloated" face - which could suggest he is experiencing weight or muscle loss from an unconfirmed illness.
Putin also seems to avoid eye contact with Shoigu presenting as a man who is fearful, uncomfortable and lacking confidence, he added.
University of Arkansas Professor Patrick Stewart echoed his comments on Putin's foot tapping and suggested this was "leakage" as the politician tried to control what could be involuntary movement.
It has long been suggested that Vladimir Putin is hiding medical problems from his people.
Previous reports claimed that the 69-year-old was being monitored by a specialist in thyroid cancer among the "elderly and senile" named Yevgeny Selivanov.
The surgeon, of Moscow's Central Clinical Hospital, was flown to see Putin at least 35 times in the Black Sea resort Sochi.
Senior figures from Australia, Canada, New Zealand, the United Kingdom and the US also advanced theories that Putin was suffering from cancer and that medical treatment had altered the balance of his mind.
While therapists recently suggested that his decision to avoid almost all contact since the start of the pandemic brought on "signs of psychosis and a personality disorder."
The reclusive dictator had been self-isolating since March 2020, only making occasional appearances.
Leading psychotherapist Noel McDermott told the Express Online that this might have caused "irreversible" damage and the move to cut-off could be a factor in his decision to invade Ukraine.
Sources claim that he is currently living in a huge underground city protected from potential attacks.
