Strokes restricted to the insular cortex.
OBJECTIVE
To characterize clinically acute insular strokes from four patients with a first ever acute stroke restricted to the insula on MRI.


METHODS
The authors studied the clinical presentation of four patients with a first ever acute stroke restricted to the insula on MRI.


RESULTS
The authors found five main groups of clinical presentations: 1) somatosensory deficits in three patients with posterior insular stroke (two with a transient pseudothalamic sensory syndrome, one with partial distribution); 2) gustatory disorder in a patient with left posterior insular infarct; 3) vestibular-like syndrome, with dizziness, gait instability, and tendency to fall, but no nystagmus, in three patients with posterior insular strokes; 4) cardiovascular disturbances, consisting of hypertensive episodes in a patient with a right posterior insular infarct; and 5) neuropsychological disorders, including aphasia (left posterior insula), dysarthria, and transient somatoparaphrenia (right posterior insula).


CONCLUSIONS
Strokes restricted to the posterior insula may present with pseudothalamic sensory and vestibular-like syndromes as prominent clinical manifestations, but also dysarthria and aphasia (in left lesions), somatoparaphrenia (right lesions) and gustatory dysfunction and blood pressure with hypertensive episodes in right lesions; we did not find acute dysphagia reported in anterior, insular strokes.
Cereda
C
C
Department of Neurology, CHUV, Lausanne, Switzerland.
Ghika
J
J
Maeder
P
P
Bogousslavsky
J
J
D000368:Aged; D002318:Cardiovascular Diseases / Q000209:etiology; D002540:Cerebral Cortex / Q000473:pathology* / Q000503:physiopathology; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology; D012042:Registries; D020886:Somatosensory Disorders / Q000209:etiology; D020521:Stroke / Q000150:complications* / Q000473:pathology / Q000503:physiopathology; D013651:Taste Disorders / Q000209:etiology; D014057:Tomography, X-Ray Computed; D015837:Vestibular Diseases / Q000209:etiology