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• W2048876296 abstract "Back to table of contents Previous article Next article LettersFull AccessA Probable Case of Reduplicative Paramnesia Status-Post Right Fronto-Temporal Cerebrovascular Accident, Treated Successfully With RisperidoneDavid R. Spiegel, M.D., Katherine Cadacio, M.D., and Masoumeh Kiamanesh, M.D.David R. SpiegelSearch for more papers by this author, M.D., Katherine CadacioSearch for more papers by this author, M.D., and Masoumeh KiamaneshSearch for more papers by this author, M.D.Published Online:1 Jan 2014https://doi.org/10.1176/appi.neuropsych.12120391AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: Generally associated with right hemisphere and frontal lobe pathology, reduplicative paramnesia is a content-specific delusion that a familiar place has been duplicated or relocated. We present a patient status after a right fronto-temporal cerebrovascular accident (CVA) who subsequently developed reduplicative paramnesia.The delusional misidentification syndrome (DMS) is a rare neuropsychiatric phenomenon that can occur in both medical and psychiatric conditions. Reduplicative paramnesia (RP) is a content-specific DMS in which a patient misidentifies a familiar place, with delusional conviction.1 There does appear to be a consensus that RP may have a neurologic rather than psychiatric cause and that right and bifrontal lesions are common factors in its presentation.2 We present here the case of a patient with new-onset reduplicative delusions status post-right frontotemporal infarct.Our patient is a 66-year-old man with history of a CVA and residual left-sided hemiparesis, admitted for “confusion.” Ultimately diagnosed with delirium due to sepsis, the latter was treated successfully with broad-spectrum antibiotics, which resolved his delirium. Although he returned to his cognitive baseline (Mini-Mental State Exam: 28/30) he developed the delusion that his hospital room was actually his home. When asked, he would reply, “everybody is telling me that I am in the hospital, but this is my house.” Physical examination was remarkable for 4/5 left-sided hemiparesis. Computed tomography scan showed right frontal and parieto-occipital cortical and subcortical infarcts. Magnetic resonance imaging done 4 months before this admission showed multifocal right cerebral acute infarcts with frontal/parietal/temporal distribution. He was treated with risperidone up to 1 mg bid, with significant attenuation of his delusion after 17 days of treatment.DMS is a neuropsychiatric syndrome in which a patient misidentifies familiar people (Capgras, Fregoli’s syndrome) or places/objects (RP) and believes that they have been replaced or transformed.1Our patient displayed symptoms of RP noted about 5 months after his right frontotemporal CVA. Interestingly, we are not the first to report a case of RP after two temporally separated, bilateral consecutive strokes.3Similar to our patient, patients with RP usually have lesions in the right hemisphere and/or bifrontal area. One study reviewed the anatomic correlates in a selected series of case reports of patients with misidentification/reduplication. They found that bilateral cortical involvement occurred frequently (41% of patients). In considering cases in which cerebral dysfunction was unilateral, the authors found that right hemispheric predominance in reduplication was highly significant (52% right hemisphere versus 7% left hemisphere).4A dual mechanism is postulated for the delusional misidentification syndromes/RP: negative effects from right hemisphere and frontal lobe dysfunction as well as positive effects from release (i.e., overactivity) of preserved left-hemisphere areas. A combination of perceptual impairment and reasoning bias creates the basis for delusion; that is, right temporal–limbic–frontal dysfunction gives rise to a distorted sense of familiarity (temporal/limbic) and impaired ability to resolve the delusion via reasoning (frontal).1,5 Left-hemisphere overactivity (posited also to play a critical role in the pathogenesis of delusions) develops after right-sided inhibition is lost.1Multiple treatments for RP have been reported;2 however, with a limited evidence-base to guide our patient’s treatment, our patient was started and improved on risperidone.While rare, our patient’s case should remind clinicians to screen for DMS/RP, status post–right-sided CVAs.Dr. David R. SpiegelDept. of Psychiatry and Behavioral SciencesEastern Virginia Medical School Norfolk, VAe-mail: Dr. Spiegel; [email protected]eduReferences1 Devinsky O: Delusional misidentifications and duplications: right brain lesions, left brain delusions. Neurology 2009; 72:80–87Crossref, Medline, Google Scholar2 Politis M, Loane C: Reduplicative paramnesia: a review. Psychopathology 2012; 45:337–343Crossref, Medline, Google Scholar3 Carota A, Calabrese P: Confabulations after bilateral consecutive strokes of the lenticulostriate arteries. Case Rep Neurol 2012; 4:61–67Crossref, Medline, Google Scholar4 Feinberg TE, Roane DM: Delusional misidentification. Psychiatry Clin North Am 2005; 28:665–683, 678–679Crossref, Medline, Google Scholar5 Moser DJ: Reduplicative paramnesia: longitudinal neurobehavioral and neuroimaging analysis. J Geriatr Psychiatry Neurol 1998; 11:174–180Crossref, Medline, Google Scholar FiguresReferencesCited byDetailsCited byClinical Neurology and Neurosurgery, Vol. 181 Volume 26Issue 1 Winter 2014Pages E11-E11 Metrics PDF download History Published online 1 January 2014 Published in print 1 January 2014" @default.
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• W2048876296 title "A Probable Case of Reduplicative Paramnesia Status-Post Right Fronto-Temporal Cerebrovascular Accident, Treated Successfully With Risperidone" @default.
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