Misidentification Syndrome and Traumatic Brain Injury

The New York Times recently featured an interesting story about misidentification syndrome brought on by traumatic brain injury.

During his first year of college, Adam Lepak crashed into a car while riding his Honda Interceptor motorcycle. Adam was wearing his helmet, but he still suffered from diffuse axonal injury. Dr. Jonathan Fellus of the Kessler Institute explained, “The textbook definition is essentially a blow that shuts down the bundle of wires responsible for keeping us conscious.”

Adam spent the next six months in a near-vegetative state. He could not talk and could barely move. Now Adam is recovering. He is walking short distances and speaking in short sentences. But there’s another problem he’ll have to overcome. Adam has trouble remembering identities - including the identity of himself and his family members.

“You’re fake,” he told his mother.

“What do you mean ‘fake,’ Adam?” she asked.

“You’re not my real mom,” he replied. “I feel sorry for you, Cindy Lepak. You live in this world. You don’t live in the real world.”

Throughout medical history, doctors have reported on patients who insist that their spouse is an imposter; that their children are body doubles; and that their closest friends and family members are fakes. The French psychiatrist Dr. Jean Marie Joseph Capgras described Capgras syndrome in 1923 with the case of a patient “who transformed everyone in her entourage, even those closest to her, such as her husband and daughter, into various and numerous doubles.”

These types of delusions, known as misidentification syndromes, are common among those who suffer from schizophrenia as well as dementia and traumatic brain injury.

Researchers have found that there is no single identity region in the brain; rather, it uses several different neural regions to maintain the identity of self and others.

The cortical midline structures are particularly active in brain processes related to personal identity. They run from the frontal lobes through the center of the brain, almost like the core of an apple. The cortical midline structures communicate with the temporal lobe, which is responsible for memory and emotion. When the lines of communication have been damaged, as in Adam’s case, mom may look and sound just like mom, but she just doesn’t seem like the same person. Somehow, she seems unreal.

Dr. Orrin Devinsky of New York University has noted that people with misidentification syndrome from traumatic brain injury typically have more damage to their right hemisphere than their left. The right hemisphere processes holistic judgments like intonation and emphasis, while the left hemisphere processes linear reasoning and language. When the left hemisphere is damaged during a traumatic brain injury accident, loved ones may lack their familiar emotional glow. But if the left hemisphere is still working, it turns to logic for an explanation: the person must be an impostor, a double, or a fake.

The best treatment for people with misidentification syndrome seems to be spending a lot of time with loved ones in familiar places. Thanks to his friends and family, Adam is making a slow but sure recovery.

If you have a loved one who has suffered from traumatic brain injury as the result of a motor vehicle accident, call MLN Law at 404-531-9700 to ask about your legal rights. You may be entitled to compensation.