title: Right insular infarction and mortality after ischaemic stroke.
abstract: Several studies have described an association between insular infarction and mortality. Large infarcts often include the insula and lesion size is associated with mortality. We hypothesized that there is an association between insular infarction and mortality independent of lesion volume.
  
  
  
  We included consecutive stroke patients between 1 September 2008 and 11 November 2012 from the 1000Plus database with an acute ischaemic lesion on diffusion-weighted imaging on day 1 and a completed 90-day follow-up. Insular infarct location was determined using the in-house software Stroke Lesion Atlas. In multiple Cox regression analysis (dependent variable: mortality), we adjusted for insular infarcts, age, lesion volume, history of atrial fibrillation, National Institutes of Health Stroke Scale and previous stroke.
  
  
  
  We included 736 patients, of whom 168 had an insular infarction. Within a medium follow-up time of 107 days, cumulative survival was 90% in patients with insular infarction and 99% in patients without insular infarction (P < 0.001). Right insular infarction was independently associated with mortality (hazard ratio, 2.60; confidence interval, 1.3-5.4; P = 0.010).
  
  
  
  In our study, right insular involvement was a prognostic marker for mortality after ischaemic stroke. A selection bias towards patients able to give informed consent warrants further studies.
authors.affiliation: Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin.
authors.forename: L
authors.initials: L
authors.lastname: Hanne
authors.affiliation: Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin.
authors.forename: P
authors.initials: P
authors.lastname: Brunecker
authors.affiliation: Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin.
authors.forename: U
authors.initials: U
authors.lastname: Grittner
authors.affiliation: Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin.|Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin.|German Center for Cardiovascular Research, Charité - Universitätsmedizin Berlin, DZHK, Berlin.|Excellence Cluster NeuroCure, Charité - Universtiätsmedizin Berlin, Berlin.|German Center for Neurodegenerative Diseases, Helmholtz Association of German Research Centres, DZNE, Berlin, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Endres
authors.affiliation: Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin.|Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin.
authors.forename: K
authors.initials: K
authors.lastname: Villringer
authors.affiliation: Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin.|Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin.
authors.forename: J B
authors.initials: JB
authors.lastname: Fiebach
authors.affiliation: Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin.|Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin.
authors.forename: M
authors.initials: M
authors.lastname: Ebinger
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications; D002545:Brain Ischemia / Q000209:etiology / Q000473:pathology; D002540:Cerebral Cortex / Q000000981:diagnostic imaging / Q000473:pathology*; D002544:Cerebral Infarction / Q000209:etiology / Q000401:mortality* / Q000473:pathology*; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D005500:Follow-Up Studies; D007839:Functional Laterality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D020521:Stroke / Q000209:etiology / Q000401:mortality* / Q000473:pathology*; D016019:Survival Analysis
keywords: cerebral infarction; insula; lesion location; magnetic resonance imaging; mortality