Somatoparaphrenia. A"positive-variant" of anosognosia for hemiplegia

Anosognosia for hemiplegia (AHP), i.e., unawareness of motor deficits and a ssociated disorders, has been frequently reported, predominantly following right hemispheric lesions. To a smaller extent, there are case reports of p atients who give accounts of a feeling of strangeness concerning the contra lesional limbs and sometimes attribute them to other persons. This "positiv e-variant" of AHP has been labeled "somatoparaphrenia" (SP). We report a case of SP in a 85-year-old woman with infarction of the right posterior cerebral artery and posterior parts of the right thalamus. She sh owed AHP and described her left side alternatively as her handicapped nephe w and a clumsy cat. Misidentification of her daughter also occurred. With r espect to the literature the predominant neuroanatomical features involved are lesions including right parietal cortex and/or posterior parts of the t halamus. Theories concerning the pathogenesis of this phenomenon comprise a denial of the illness, a lack of awareness caused by reduced sensory feedb ack and neglect, a misidentification or disturbance of the active discovery process considered necessary for realizing one's disorder.