The railway station in the hospital

Train_bedSeveral years ago, during the visit in the morning, I discussed with a 75  y o man who suffered from a multifocal stroke of the right hemisphere few days before. He had left spatial neglect and anosognosia of hemiparesis, some loss of sensory on the left body. He was not confused although he showed severe attention deficits. The motor deficit was not severe. He knew he was in the hospital and that he had some brain disease. He said calmly to me that the hospital room was part of the railway station of the town where he lived. Actually, he was as sure of that location as, during the night, he get in a train and travelled for a 300 km round trip. It was impossible to persuade him that this was only his hospital room. I had a similar conversation the day after. Two days after he said that, during the night, some workers separated completely the railway station from the hospital room and took it away.
“Reduplicative paramnesia” is the delusional belief that a place or location has been duplicated, existing in two or more places simultaneously, or that it has been ‘relocated’ or added to another site. This behavioral disorder can occur with right hemisphere stroke but also with dementia (especially Lewy Body Disease), brain trauma but it has been reported in psychiatric patients too.
This false conviction should originate from a mistmacth among processes of memory, familiarity, emotions, visuo-spatial recognition and reality checking. However, the mechanisms remain speculative. In this patient reduplication of places associated with confabulations that were related to the specific context of space and locations (train trip/railway station).It has been postulated that the right hemisphere lesions create the false experiences of duplication of places as there is impairment in visual recognition, loss of self-boundaries, dysfunction or mismatch between memory, emotions and recognition. The left hemisphere (the devil’s advocate) which is the logic hemisphere might create false beliefs to give some credibility to the impaired perceptions. What could it happen whether the medical staff play roles according to the patient’s confabulations (for example asking him to validate the ticket of the train?). After stroke of the right hemisphere, the process of recovery from reduplicative paramnesia is somehow mysterious

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