title: Preserved self-awareness following extensive bilateral brain damage to the insula, anterior cingulate, and medial prefrontal cortices.
abstract: It has been proposed that self-awareness (SA), a multifaceted phenomenon central to human consciousness, depends critically on specific brain regions, namely the insular cortex, the anterior cingulate cortex (ACC), and the medial prefrontal cortex (mPFC). Such a proposal predicts that damage to these regions should disrupt or even abolish SA. We tested this prediction in a rare neurological patient with extensive bilateral brain damage encompassing the insula, ACC, mPFC, and the medial temporal lobes. In spite of severe amnesia, which partially affected his "autobiographical self", the patient's SA remained fundamentally intact. His Core SA, including basic self-recognition and sense of self-agency, was preserved. His Extended SA and Introspective SA were also largely intact, as he has a stable self-concept and intact higher-order metacognitive abilities. The results suggest that the insular cortex, ACC and mPFC are not required for most aspects of SA. Our findings are compatible with the hypothesis that SA is likely to emerge from more distributed interactions among brain networks including those in the brainstem, thalamus, and posteromedial cortices.
authors.affiliation: Division of Behavioral Neurology and Cognitive Neuroscience, Department of Neurology, University of Iowa, Iowa City, Iowa, United States of America.
authors.forename: Carissa L
authors.initials: CL
authors.lastname: Philippi
authors.forename: Justin S
authors.initials: JS
authors.lastname: Feinstein
authors.forename: Sahib S
authors.initials: SS
authors.lastname: Khalsa
authors.forename: Antonio
authors.initials: A
authors.lastname: Damasio
authors.forename: Daniel
authors.initials: D
authors.lastname: Tranel
authors.forename: Gregory
authors.initials: G
authors.lastname: Landini
authors.forename: Kenneth
authors.initials: K
authors.lastname: Williford
authors.forename: David
authors.initials: D
authors.lastname: Rudrauf
mesh_terms: D001364:Awareness / Q000502:physiology*; D001519:Behavior / Q000502:physiology; D001930:Brain Injuries / Q000503:physiopathology*; D003243:Consciousness / Q000502:physiology; D005145:Face; D059907:Functional Neuroimaging; D006179:Gyrus Cinguli / Q000293:injuries* / Q000503:physiopathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D017397:Prefrontal Cortex / Q000293:injuries* / Q000503:physiopathology*; D021641:Recognition, Psychology / Q000502:physiology; D012903:Smell / Q000502:physiology