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  1. Mirror Image Agnosia
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Mirror Image Agnosia

Face-sensitive brain evoked response N is of shorter latency and larger amplitude for upright human faces. Inverted images produce changes that are proportional to the candidates expertise in upright face Rossan et al. PET scan shows right hippocampus activation during unfamiliar face registration, left frontal and inferior temporal for face encoding, right prefrontal, bilateral parietal, and ventral occipital for face recognition proving hemisphere encoding and retrieval asymmetry HERA hypothesis HERA hypothesis by Tulving.

The way brain deals with mirror images is a source of fascination Coballis ; Gregory , but normal human brain does not confuse a mirror reflection of self as well as objects as long as the person knows he is looking at a mirror. Reflected images of self are more peculiar as one has never seen his or her self other than in reflection and recognized by comparison with body schema unlike faces of others and objects which carry a polymodal lexicon. Different parts of the occipital lobe are reported to be involved in processing living and nonliving things Humphreys According to the classical theory of face recognition gender, age, and expressions are processed independent of one another Bruce and young, ; Ellis and Lewis Agnosias in face recognition can be selective within the Prosapagnosia in the sense it can be for either familiar face, famous face, smiling face, crying face, laughing face or novel face and reflected face in isolation.

Failure to recognize the emotions in face could be one cause of indifference in some patients with degenerative dementias and also data linking disorders like Capgras syndrome.

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Mirror Agnosia is a condition where even though the person knows that he is looking at mirror as evidenced by ability to identify the frame and the glass of the mirror, he fails to recognize the objects that are reflected in the mirror as reflections. Therefore, when asked to localize the object, instead of looking for the original object in its place, he will search for the object into the mirror resulting in damage to the mirror. Such patients while driving and looking at the rear view mirror imagine the vehicles behind to be in front and land themselves in accidents.

Thus, his world becomes locked inside his looking glass. There is no problem in recognizing images in the rear view mirror and locating the vehicles as coming from behind, no difficulty in identifying the reflected images of the inanimate objects like ornaments and dress as reflected images of their ornaments or objects, but they have specific difficulty in identifying their own reflected images in the mirror and mistake them as strangers, Gods, or enemies and behave appropriately.

In this study, we report a rare syndrome of mirror image agnosia with domain specific failure to recognize reflected image of self. To our knowledge this phenomena is not reported in the literature. Sixty-two-year-old female was brought to the hospital with features of forgetfulness and getting lost in less familiar environment. She was often found attracted to the mirror in the house and was found conversing with the mirror image. Evaluation revealed moderate dementia of the posterior type. She did not suffer from weakness of limbs, deafness, or blindness.

She had no apraxias, aphasias, or neglects. She was then asked to identify her close relatives at least two of them by sight and also was asked to match them with their photos. She could identify the famous face of Mahatma Gandhi, crying child, laughing child, and surgeons face. She could identify it as a mirror. She showed unusual attraction to the mirror and ignored the physician and people around. Informed consent was taken for video Video 1.

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Eighty-year-old patient with visual hallucinations and memory impairment was found to have a HMSE score of She also could identify the mirror and reflected images of others, but she initially mistook her image as God and started worshipping and soon started fighting, asking the reflected image, why she was wearing her nose stud, indicating that she has correctly identified her nose stud. Informed consent taken for video Video 2.

134 364 looking in mirror stock photos, vectors, and illustrations are available royalty-free.

In this patient, we attempted FMRI using the photo of the patient as well that of the reflected image, as test paradigm. However we were not successful in creating artifact free data. She was a retired major in the army who had classical features of Alzheimer's disease clinically and radiologically. Her HMSE score was She was found to be fighting with her image in the mirror and on two occasions she had broken the mirror with her kicks. She mistook the image as a thief.

She did not give consent for video. She was a year-old person who was disoriented to place. She declared her children as imposters. Later the relatives noted she was discussing her family matters with her own image. When asked she declared the image as an old friend. He is a year-old farmer from Bangladesh. His illness started as memory disturbances and later developed way finding problems, severe confusion in dressing but no ideational or ideomotor apraxia. He in addition had consistent difficulty in identifying his own reflected image and claimed it to be a friend.

He also had difficulty with the reflected face of his son which was inconsistent, though he could identify the son by looking at him. All patients underwent neuropsychological assessment, all mandatory investigations such as HIV, VDRL, B12, renal, hepatic and thyroid function, tests for praxis, neglects, and gnosis. All patients were started on disease-modifying drug Donepezil which was started as 2. None received any psychotropic agents.

One patient improved during follow up at 12 months from the symptoms which were referable to her difficulty in identifying her reflected image. But whether she had regained the ability to recognize her reflected image, is not clear as the other parameters had deteriorated and patient was not fit for tests of Gnosis. MRI done in 1. There was temporal lobe involvement in one patient, in addition to parietal and diffuse atrophy in one case. T1 and T2 weighted images show right lateral ventricle larger than left with diffuse atrophy. Insula and parietal regions show more widening of sulci on the right compared to left.

Reflected self-images are special because the individual has never seen his or her real face; therefore, unlike the face of others the visual elements of the lexicon are derived only from the reflected image. Body schema is in the nondominant parietal lobe. This lobe is concerned with only dressing apraxia, visuospatial disorientation, neglects and no other apraxias. Previous studies suggest that there is highly specific representation for various kinds of faces, their emotions, primate versus man, inverted versus upright, and living versus nonliving.

Our hypothesis is that probably mirror images are processed in the right parietal lobe. Associated delusional misidentification and Capgras effect point to break down of data linking circuits.

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  • There is also nonsyndromic hereditary prosopagnosia reported. Highly specialized neural circuits deal with reflected self-images and there is early break down of this in patients with posterior dementias. This probably is mistaken as a behavioral syndrome rather than as structural brain disease.

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    As disease advances patients do not show this symptom as progression makes it more generalized. Further evaluation of a larger number of patients with PET and FMRI is likely to yield insight in to the way the brain processes mirror images. Source of Support: Nil. Conflict of Interest: None declared. National Center for Biotechnology Information , U.

    Indian J Psychol Med. Author information Copyright and License information Disclaimer. Address for correspondence: Dr. E-mail: moc. This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3. This article has been cited by other articles in PMC. Abstract Background: Gnosis is a modality-specific ability to access semantic knowledge of an object or stimulus in the presence of normal perception. One language will limit description of experience, whereas another will describe it in quite a different way. The experience transcends language.

    It is a big mistake to confuse the discrete wordular description in any singular language with the actual perceived experience. Another reason that I know this "theory" is rubbish is that I have been out of body many times and have blundered into areas where there is absolutely no language to describe what I experienced. Thus there is a severe distinction between language and intimately experienced personal experience. Language is a tool of expression.

    It is NOT a defining or causal agent for experience. Only simplistic and naive people would think their verbal description equals or causes an experience. There are many such people unfortunately: some even have letters after their names.

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    How much do you trust the mirror vs a photo of yourself?

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