title: Reduced perception of dyspnea and pain after right insular cortex lesions.
abstract: BACKGROUND
  The perception of dyspnea and pain show many similarities. Initial imaging studies suggested an important role of the insular cortex for the perception of both sensations. However, little is known about the cortical processing of dyspnea.
  
  
  OBJECTIVE
  This study investigated the influence of lesions of the insular cortex on the perception of dyspnea and pain.
  
  
  METHODS
  Dyspnea was induced by resistive loaded breathing in four patients with right-hemispheric insular cortex lesions, as assessed with computer tomography or magnetic resonance imaging, and four matched healthy control subjects. Pain was induced by a cold-pressor test. Perceived intensity and unpleasantness of both sensations were rated on visual analog scales.
  
  
  RESULTS
  In contrast to healthy control subjects, patients with lesions demonstrated reduced perceptual sensitivity for dyspnea, in particular for the unpleasantness of dyspnea (P < 0.05). This was paralleled by reduced sensitivity for pain in patients with lesions, as reflected by smaller ratings of intensity and unpleasantness, higher sensory pain-thresholds, and, in particular, higher affect-related pain tolerance times (P < 0.05).
  
  
  CONCLUSIONS
  The results suggest that lesions of the right insular cortex are associated with reduced sensitivity for the perception of dyspnea and pain, in particular for their perceived unpleasantness. This underlines the importance of the insular cortex for the perception of both sensations.
authors.affiliation: Department of Psychology, University of Hamburg, Hamburg-Eppendor, Germany.
authors.forename: Daniela
authors.initials: D
authors.lastname: Schön
authors.forename: Michael
authors.initials: M
authors.lastname: Rosenkranz
authors.forename: Jan
authors.initials: J
authors.lastname: Regelsberger
authors.forename: Bernhard
authors.initials: B
authors.lastname: Dahme
authors.forename: Christian
authors.initials: C
authors.lastname: Büchel
authors.forename: Andreas
authors.initials: A
authors.lastname: von Leupoldt
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D002540:Cerebral Cortex / Q000503:physiopathology*; D002544:Cerebral Infarction / Q000503:physiopathology* / Q000523:psychology*; D004417:Dyspnea / Q000209:etiology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D017288:Pain Threshold / Q000502:physiology*