"Mirror, mirror on the wall, who...?": towards a model of visual self-recognition.

Self-recognition and self-awareness are processes fundamental to human development. This report describes the case of an 80-year-old woman who demonstrated the ''mirror sign'', an inability to recognise the reflection of oneself in a mirror. An attempt has been made to provide a cognitive neuropsychological explanation for this profound impairment in visual self-recognition, incorporating current cognitive theories of delusion formation and, specifically, delusions involving distorted appreciation of the self or others. We speculate that the impairment in visual self-recognition arises from deficits in visual and personal semantic memory related to bilateral hippocampal lesions, and that the greater extent of impairment in visual self-recognition compared with that for other familiar persons is possible evidence for a specific self-recognition process, represented as a separate ''self-identity node'' in the current face-processing model of Bruce and Young (1986).