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Hyposchematia Without Spatial Neglect in 2 Patients With Lesions Involving the Insula

Kumral, Emre PhD, MD; Evyapan, Dilek MD; Şirin, Tuba MD; Alpaydin, Sezin MD

Cognitive and Behavioral Neurology: September 2012 - Volume 25 - Issue 3 - p 149–153
doi: 10.1097/WNN.0b013e31826b70de
Case Reports

Background: Hyposchematia is a rare variant of aschematia in which patients underestimate the size of part or all of their body. The term also describes an abnormality in drawing tasks, in which patients underestimate the size of 1 side of an image and draw it too small. Little is known about the neuroanatomy of the syndrome.

Case Reports: We report 2 patients who developed contralateral hyposchematia without spatial neglect after suffering an ischemic lesion involving the right insula. Both patients felt that the left side of their face and their left arm and leg were disproportionately smaller than their right. On a drawing task, both patients drew the left sides of objects smaller than the right; they perseverated on the left sides of the images, for example, adding extra left-sided petals to a daisy.

Conclusions: In 2 reported patients, the cause of hyposchematia may be a lesion involving multiple insular circuits that affect the perception of extrapersonal space and self-related systems.

Neurology Department, Medical School Hospital, Ege University, Izmir, Turkey

E.K. and D.E. designed and supervised the study. T.S. and S.A. acquired the data.

The authors declare no conflicts of interest.

Reprints: Emre Kumral, PhD, MD, Department of Neurology, Ege University, Medical School, Stroke Unit, Bornova, Izmir 35100, Turkey (e-mail:

Received December 23, 2011

Accepted March 16, 2012

© 2012 Lippincott Williams & Wilkins, Inc.