Patients with stroke or other brain lesions may remain unaware and explicitly deny their neurological defi cits, including paralysis, blindness, amnesia, and aphasia – a phenomenon called anosognosia. The neuropsychological disorders and neuroanatomical substrates underlying anosognosia are still poorly known. Whereas purely psychological defense mechanisms cannot account for it, no unique neuropsychological deficit in executive function, reasoning, or memory appears to be consistently linked to anosognosia. This chapter fi rst reviews the most common forms of anosognosia for different domains of defi cits and then focuses on denial of hemiplegia.Evidence from recent studies on the latter case suggests a role of multiple component defi cits affecting not only motor control, attention, or proprioception but also emotional and self-monitoring systems implicated in error detection as well as belief formation and updating. These abilities are likely to rely on a distributed network of brain areas, possibly including limbic and subcortical circuits in insula, basal ganglia,and amygdala, in addition to premotor and executive control systems.