Brain atrophy and interhemispheric fissure enlargement in Cotard's syndrome.

The hallmark of Cotard's syndrome is the delusion of being dead. The literature indicates that it is often associated with parietal lobe lesions. This association was investigated by blindly comparing the computed tomographic scans of eight patients who had Cotard's syndrome (one of whom is described) with those of eight controls matched as closely as possible for age, sex, race, and principal psychiatric diagnosis. Two trends emerged. Compared with controls, patients with Cotard's syndrome had more brain atrophy in general and more median frontal lobe atrophy in particular. Parietal disease did not discriminate between the index and control groups. Cotard's syndrome may be associated with multifocal brain atrophy and medial frontal lobe disease.