The Delusions of Capgras and Intermetamorphosis in a Patient with Right-Hemisphere White-Matter Pathology

Abstract

Previous neuropsychological studies have demonstrated an association between person misidentification and right-hemisphere dysfunction. In the study reported here, we explore the contribution of facial and visual recognition impairments in a patient with right-hemisphere subcortical white-matter pathology in the frontal and parietal lobes and a diagnosis of vascular cognitive impairment. The patient displayed false recognition of unfamiliar faces and deficient retrieval of key biographic detail for famous faces. These results are discussed in the context of the contribution of deficiencies in the visual system and subcortical white-matter lesions to the development of Capgras delusion.

Coexistência das síndromes de Capgras e Frégoli associadas à redução de volume frontotemporal e hiperintensidades em substância branca cerebral

“…Previous reports have been largely restricted to grey matter, and as far as we know, there was only one previous report of WMH lesions affecting the brainstem in DMS 6 . The presence of deep WMH suggests that DMS could result from a disruption of connections involving frontal lobe to other cortical and subcortical areas.…”

“…Previous authors have suggested that impairment in facial recognition plays a role in the pathogenesis of DMS 6 . Some studies have demonstrated impairment in judging facial emotions in patients with the diagnosis of schizophrenia associated to a global impairment in social skills which results from a right hemisphere dysfunction.…”

“…Reports of DMS associated to brain injury or neurological conditions have led to the investigation of the neuroanatomic basis to these conditions 5 . DMS have been associated to bilateral cortical volume loss with right hemisphere predominance, involving frontal, parietal and temporal lobes so these syndromes have been classified as "right hemisphere damage delusions" 6 .…”

“…Some studies have demonstrated impairment in judging facial emotions in patients with the diagnosis of schizophrenia associated to a global impairment in social skills which results from a right hemisphere dysfunction. However, in DMS there is a more specific impairment in facial recognition, which is also associated to right hemisphere alterations 6 . The delusional symptoms in Capgras syndrome could be the result of a right temporolimbic-frontal disconnection which results in impossibility to associate previous memories to new information and consequently misidentifying symptoms 1 .…”

“…Frégoli syndrome has also been associated to impairment in face processing 1 . Facial processing involves right ventromedial occipito-temporal regions and areas of prefrontal cortex via the uncinate fasciculus and limbothalamic pathways 6 .…”