Capgras Syndrome and Phantom Vest Following Traumatic Brain Injury

Abstract

Background: Delusional misidentification syndromes are uncommon and occur predominantly in persons with acquired brain injuries and neurodegenerative disorders. To our knowledge, the sensation of a phantom piece of clothing has not been reported in the literature. We present a patient with episodic Capgras syndrome and the persistent hallucination of wearing a vest following a traumatic brain injury (TBI). Case History: The patient is a 31-year-old left-handed man who experienced a severe TBI. On exam, he exhibited left hemineglect and left hemiparesis. He experienced Capgras delusion, in which he believed his wife was an imposter. The delusion only occurred when she was present in his room, not when they talked on the phone, and was typically triggered when his wife was in his neglected hemispace. He additionally reported the constant, hallucinated, sensation of wearing a vest. Computed tomography revealed injury to bilateral (predominantly right-sided) frontal polar, orbitofrontal, and anterior temporal structures and to right dorsolateral and temporoparietal structures. Conclusion(s): This patient experienced Capgras delusion in the visual but not auditory modality following TBI. Our findings support the hypothesis that disruption of right-hemispheric pathways connecting facial recognition and limbic-paralimbic areas can cause Capgras delusions. Right hemisphere damage also underlies disturbances of body representation. Coupled with impaired insight arising from lesions to these and frontopolar areas, disorders of body representation may extend to false perceptions of body accoutrements such as clothing, in addition to disturbances in the perception of the body itself.