October 26, 2015: The Cotard Delusion

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October 26, 2015

The Cotard Delusion

The Cotard Delusion, also known as Walking Corpse Syndrome, is a rare neurologically based delusion in which patient perceive that they, or parts of their body, are deceased, resulting in a de-realization delusion. Greater than 50% of patients who develop this affliction also have denial of self-existence. While primarily thought of as a psychiatric delusion given its association with depression, psychosis and schizophrenia, there are rare reports of association with migraine with aura, traumatic brain injury, organic lesions of the non-dominant temporoparietal cortex, and accumulation of acyclovir and its substrate, 9-carboxymethoxymethylguanine, in the central nervous system. The Cotard Delusion is thought to be a result of abnormal neural communication in the fusiform gyrus and the amygdala, which are associated with recognition of faces and their associated emotional attachment respectively, although given the rarity of this finding this has not been demonstrated on neuroimaging studies. The delusion is on a similar spectrum and can occasionally occur in conjunction with Capgras Syndrome in which patients are unable to recognize familiar faces, often interpreting known persons as impostors. Treatment of this disorder is by treatment of the associated condition and reports of success with antidepressants, antipsychotics, and electroconvulsive therapy have been reported.

  1. Pearn J, Gardner-Thorpe C. Jules Cotard (1840-1889): His life and the unique syndrome which bears his name. Neurology 2002; 58:1400-1403.
  2. Debruyne H, Portzky M, Van den Eynde F, Audenaert K. Cotard's syndrome: A Review. Current Psychiatric Reports 2010; 11: 197–202.

Submitted by Jonathan D Santoro, MD, Division of Child Neurology, Lucile Packard Children’s Hospital at Stanford, Palo Alto, CA.

Disclosures: Dr. Santoro reports no disclosures.

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