“I Do Not Exist”—Cotard Syndrome in Insular Cortex Atrophy

Cotard syndrome is a fascinating entity, in which the patient lingers under extreme nihilistic delusions. While its etiology is still unclear, modern imaging techniques have revealed interesting possibilities regarding the role of insular cortex in mediating interoception and selfperception. Our paper reports development of Cotard syndrome in a 65-years old female suffering from symptoms of dementia and depression, who’s subsequent MRI revealed atrophy of bilateral insular cortices. We propose that etiology of Cotard syndrome in this case may be a reduction in her ability to validate internal perception against external information and subsequent coloring of anomalous perceptions by depressive cognitions.