Delusional misidentification syndromes (DMS) are a group of rare and varied disorders in which, in their typical form, the patient thinks that a particular familiar person is someone else or a familiar place is a duplicate. DMS may occur in the presence of idiopathic psychiatric diseases, in diffuse brain diseases or in focal neurological diseases. It was first identified and considered a memory disorder by Pick who described the syndrome of reduplicative paramnesia. Despite the relation of DMS to psychotic states, it is widely considered but difficult to confirm that these syndromes have an anatomical basis. The literature reports the poor localization of brain lesions, nevertheless lesions in the right temporal lobe have been described. Also lesions in the anterior medial part of the right temporal lobe, medial frontal and orbital frontal regions bilaterally or discrete lesions in the right anterior inferior temporal lobe. DMS have been recently associated with cognitive deficits. Working memory is significantly impaired in these patients, which may be associated with alterations at the right frontal region. A combination of executive and memory deficits have also been reported. Since the first DMS description, similar variants have been reported, like the Frégoli syndrome, in which the patient conceptually misidentifies a person as another known person with an entirely different appearance – involving “hiper-identification”. The aetiology of Frégoli syndrome is still not well reported, although there are cases reported associated with epilepsy, stroke, Alzheimer dementia and head injury. The neurobiological basis of Frégoli syndrome is also not well reported, still some hypothesis have been postulated. One hypothesis considers that inter hemispheric disconnection of cortical areas allows each hemisphere to establish independent images, in this case the patient deals with this discrepancy by confabulating. More research is needed to establish the neurobiological basis for the DMS and a more precise association to brain injury. We present a case report of a Frégoli syndrome occurred 2 years after a traumatic brain injury. CASE REPORT A 19 year old male, who suffered a severe car crash in Was admitted in Neurosurgery, with a Glasgow Coma Scale of days in Intensive Care Unit. 10 days with assistant ventilation; pulmonary pathology. CT scan showed multiple temporal bilateral concussions. MRI showed lesions in the first frontal lobe circumvolution, bilateral lesions in the basal ganglia and right side of corpus callosum. Diffuse neuronal disruption. January 2002: Diagnosis: severe TBI, decerebration, spastic tetraparesis, paralysis III right nerve. Barthel Index of 0/100 and a Functional Independence Measure of 18. March 2002: Discharged with a Barthel Index of 90/100 and a Functional Independence Measure of 120. May 2002: Neuropsychological evaluation: Frontal lobe syndrome – impairment in: memory, executive functions, attention, behavior and personality change. June–December 2002: Rehabilitation clinic. February 2003: Attentional and memory impairment. Less disinhibition, less impulsive, humour stabilized, development of compensatory strategies. March–May 2003: Planning compensatory strategies; psychotherapy; family guidelines. June 2003–January 2004: Cognitive Rehabilitation. January 2004: A delusional misidentification syndrome (DMS) - Fregoli’ Syndrome. Diagnosed in the sequence of an acute psychotic episode, firstly considered a primarily psychotic disorder. No relevant personnel and family history. Psychiatric medication (Olanzapine) was taken for 4 months. Cognitive rehabilitation was reinitiated and vocational counselling was performed. The patient is presently in a landscaping course. Fregoli Syndrome is rare among acquired brain injuries, but still it might be important to take it in consideration in order to avoid misinterpretations of psychotic symptoms. s Traumatic Brain Injury and Fregoli’s Syndrome Pires-Barata S 1, Palma Gois L 2, Teixeira da Silva MH 1 Physical Medicine and Rehabilitation Department 1, Psychiatric Department 2 Hospital do Espírito Santo Évora EPE, Portugal