Crossed somatoparaphrenia: an unusual new case and a review of the literature

Somatoparaphrenia is a delusional misidentification and confabulation of body parts, usually arm or hand, opposite to a cerebral lesion, generally of the "minor" right hemisphere. There is some controversy concerning lesion site ( fronto-parietal; parieto-temporal; posterior insula, additional subcortical nuclei) or necessary associated symptoms ( hemiparesis/plegia, anosognosia, neglect, position sense deficit). We here present a patient who is unusual in many respects, that is: ( 1) he is a right-hander with somatoparaphrenia after a "dominant" left-hemisphere lesion associated with aphasia and ideomotor apraxia, but also with right hemineglect. He thus has "crossed" somatoparaphrenia; ( 2) his delusional misidentification concerned the right leg and not the arm or hand; ( 3) he has no anosognosia; ( 4) his proprioception is disturbed for the leg only; and ( 5) the lesion site is very posterior, a left occipito-parietal haemorrhage without involvement of the frontal lobe or the posterior insula. We present this case together with the seven other cases of "crossed somatoparaphrenia" with and without aphasia we found since 1935 in the literature and discuss their relevance in relation to the above controversies.