Mirror Image Agnosia

By Chandra, Sadanandavalli; Issac, Thomas | Indian Journal of Psychological Medicine, October-December 2014 | Go to article overview

Mirror Image Agnosia


Chandra, Sadanandavalli, Issac, Thomas, Indian Journal of Psychological Medicine


Byline: Sadanandavalli. Chandra, Thomas. Issac

Background: Gnosis is a modality-specific ability to access semantic knowledge of an object or stimulus in the presence of normal perception. Failure of this is agnosia or disorder of recognition. It can be highly selective within a mode. self-images are different from others as none has seen one's own image except in reflection. Failure to recognize this image can be labeled as mirror image agnosia or Prosopagnosia for reflected self-image. Whereas mirror agnosia is a well-recognized situation where the person while looking at reflected images of other objects in the mirror he imagines that the objects are in fact inside the mirror and not outside. Material and Methods:: Five patients, four females, and one male presented with failure to recognize reflected self-image, resulting in patients conversing with the image as a friend, fighting because the person in mirror is wearing her nose stud, suspecting the reflected self-image to be an intruder; but did not have prosopagnosia for others faces, non living objects on self and also apraxias except dressing apraxia in one patient. This phenomena is new to our knowledge. Results: Mirror image agnosia is an unique phenomena which is seen in patients with parietal lobe atrophy without specificity to a category of dementing illness and seems to disappear as disease advances. Discussion: Reflected self-images probably have a specific neural substrate that gets affected very early in posterior dementias specially the ones which predominantly affect the right side. At that phase most patients are mistaken as suffering from psychiatric disorder as cognition is moderately preserved. As disease becomes more widespread this symptom becomes masked. A high degree of suspicion and proper assessment might help physicians to recognize the organic cause of the symptom so that early therapeutic interventions can be initiated. Further assessment of the symptom with FMRI and PET scan is likely to solve the mystery of how brain handles reflected self-images. Conclusion: A new observation involving failure to recognize reflected self-images is reported.

Introduction

Gnosis is a modality specific ability to access semantic knowledge of an object or stimulus in the presence of normal perception. Failure of this is Agnosia or disorder of recognition. [sup][1] Various sensory organs convey semantic information by several modes. When a peacock is seen; its beauty is appreciated, its name is read, its shrill cry and its name heard, its silky feathers felt in concerned association areas, this polymodal information is associated and stored as lexicon in the ventral temporo-parieto-occipital region. According to Lissauer, Agnosia can be Apperceptive if the elementary information such as the size, shape, loudness, and texture are not converted into a unified image or Associative if the primary capacities are recognized but not synthesized into semantic information comparing it with previous experience. Therefore, the person can copy an image or imitate a gesture but cannot recognize which occurs in Prosapagnosia and pure Alexia. [sup][2] This term was introduced by Sigmund Freud in 1891 and Milner called it normal percept devoid of its meaning. Agnosias generally affect one modality only and patient will recognize by other modes. It can be also selective within one modality like Colour Agnosia and prosopagnosia. The criteria for diagnosis are failure to recognize an object in the presence of normal perception and ability to identify through intact mode and absence of significant dementia. The disturbance of higher visual perceptions can manifest as visual distortions such as metamorphopsia, palinopsias, allesthesias, simultagnosia; visual object Agnosia; and apperceptive problems. [sup][1],[3]

Prosopagnosia

Faces are biologically very significant as it provides information critical for negotiation of the social world. …

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