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Guthrie and Grossman studied in detail two cases of a denial syndrome, one occurring in a woman with diffuse cortical atrophy of undetermined cause,
and the other in a man who suffered a cerebrovascular accident in the right hemisphere. The first patient denied the existence of the entire left side of her body, the side which was symptomatically affected with both motor and sensory impairment. When confronted with her left hand she said that it was not hers but that of the examiner. The second patient vigorously denied three of his major defects, blindness, inability to use the left upper extremity, and inability to walk. As these symptoms improved, he gradually stopped denying his defects.
A study of premorbid personalities and past histories of these two patients revealed that denial of illness had been a lifelong pattern in both. In the first patient this was specifically related to handedness and to a strong dichotomy between good and evil, while in the second patient there had been a particular exposure and emotional reaction to the subject of blindness. The attitude of denial, when employed against a minor illness, does not evoke much attention but when it is used against a major threat, such as hemiplegia or blindness, it is more likely to stand out as bizarre.
In conclusion, the authors doubt that anosognosia is a topographically determined symptom of lesions interrupting the thalamocortical pathways of the minor cerebral hemisphere, but agree rather with those authors who consider it a defense mechanism against the threat of internal disorganization.