title: The no smoking sign--insular infarction.
abstract: BACKGROUND
  Cigarette smoking is the most common preventable cause of morbidity and mortality in developed countries. Smokers with brain damage involving the insula are 136 times more likely to stop smoking immediately after the injury than smokers with brain injuries elsewhere.
  
  
  METHODS
  Case Report.
  
  
  RESULTS
  A 58-year-old woman with a history of hypertension, coronary artery disease, and 40 pack-year history (1 pack per day for 40 years) of smoking presented with sudden confusion and word-finding difficulty. Initial neurological examination showed disorientation to time, difficulty following commands, and perseveration. No focal motor, sensory, or visual deficit was present. Noncontrast head CT showed a new insular ischemic stroke. Five months after discharge from the hospital, the patient reported that she had not resumed smoking cigarettes, had not used any smoking cessation aids, and had not intended to stop smoking. Her daughter reported that "it was as if she forgot that she used to smoke."
  
  
  CONCLUSIONS
  Unintentional abrupt smoking cessation serves as a unique lesion localizer. Insular hypocretin transmission plays a permissive role in the motivational properties of nicotine in animals. Whether the mechanism of smoking cessation relates to hypocretin secretion has yet to be proven in humans.
authors.affiliation: Department of Neurology, Henry Ford Hospital, Detroit, MI 48202, USA.
authors.forename: Hebah
authors.initials: H
authors.lastname: Hefzy
authors.forename: Rachel Wulf
authors.initials: RW
authors.lastname: Silver
authors.forename: Brian
authors.initials: B
authors.lastname: Silver
mesh_terms: D001925:Brain Damage, Chronic / Q000000981:diagnostic imaging* / Q000503:physiopathology* / Q000523:psychology; D002545:Brain Ischemia / Q000000981:diagnostic imaging* / Q000503:physiopathology* / Q000523:psychology; D002540:Cerebral Cortex / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D012907:Smoking / Q000503:physiopathology* / Q000523:psychology; D016540:Smoking Cessation; D014057:Tomography, X-Ray Computed