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NEUROLOGY 1992;42:1727
© 1992 American Academy of Neurology

Cardiovascular effects of human insular cortex stimulation

Stephen M. Oppenheimer, MB, MRCP, FRCPC, Adrian Gelb, MB, ChB, FRCPC, John P. Girvin, MD, PhD, FRCSC and Vladimir C. Hachinski, MD, DSc(Med), FRCPC

Cerebrovascular Program, Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD (Dr. Oppenheimer)
Department of Stroke and Aging, The John P. Robarts Research Institute, London, ON, Canada (Drs. Oppenheimer and Hachinski)
Departments of Clinical Neurological Sciences, University of Western Ontario, London, ON, Canada (Drs. Oppenheimer, Gelb, Girvin, and Hachinski)
Departments of Anesthesia, University of Western Ontario, London, ON, Canada (Dr. Gelb).

Recent investigations indicate a site of cardiac representation within the left insular cortex of the rat. Moreover, the results of lesion studies suggest left-sided insular dominance for sympathetic cardiovascular effects. It is unclear whether similar representation exists within the human insular cortex. Five epileptic patients underwent intraoperative insular stimulation prior to temporal lobectomy for seizure control. On stimulation of the left insular cortex, bradycardia and depressor responses were more frequently produced than tachycardia and pressor effects (p < 0.005). The converse applied for the right insular cortex. We believe this to be the first demonstration of cardiovascular changes elicitable during insular stimulation in humans, and of lateralization of such responses for a cortical site. In humans, unlike the rat, there appears to be right-sided dominance for sympathetic effects. These findings may be of relevance in predicting the autonomie effects of stroke in humans and in the explanation of sudden unexpected epileptic death.

Address correspondence and reprint requests to Dr. Stephen Oppenheimer, Director, Cerebrovascular Program, Meyer 5-185, The Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD 21205.

Received November 18, 1991. Accepted for publication in final form February 19, 1992.




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PNAS, April 27, 1999; 96(9): 5268 - 5273.
[Abstract] [Full Text] [PDF]

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 ANN INTERN MEDHome page
E. R. Locatelli, J. P. Varghese, A. Shuaib, and S. J. Potolicchio
Cardiac Asystole and Bradycardia as a Manifestation of Left Temporal Lobe Complex Partial Seizure
Ann Intern Med, April 6, 1999; 130(7): 581 - 583.
[Full Text] [PDF]

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M. Nowak, K. S. Olsen, I. Law, S. Holm, O. B. Paulson, and N. H. Secher
Command-related distribution of regional cerebral blood flow during attempted handgrip
J Appl Physiol, March 1, 1999; 86(3): 819 - 824.
[Abstract] [Full Text] [PDF]

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 StrokeHome page
B. Diehl, R. R. Diehl, S. R. G. Stodieck, and E. B. Ringelstein
Spontaneous Oscillations in Cerebral Blood Flow Velocities in Middle Cerebral Arteries in Control Subjects and Patients With Epilepsy
Stroke, December 1, 1997; 28(12): 2457 - 2459.
[Abstract] [Full Text]

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 Arch NeurolHome page
B.-W. Yoon, C. A. Morillo, D. F. Cechetto, and V. Hachinski
Cerebral Hemispheric Lateralization in Cardiac Autonomic Control
Arch Neurol, June 1, 1997; 54(6): 741 - 744.
[Abstract] [PDF]

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J. T. Korpelainen, K. A. Sotaniemi, H. V. Huikuri, and V. V. Myllyla
Abnormal Heart Rate Variability as a Manifestation of Autonomic Dysfunction in Hemispheric Brain Infarction
Stroke, November 1, 1996; 27(11): 2059 - 2063.
[Abstract] [Full Text]

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 StrokeHome page
H. K. Naver, C. Blomstrand, and B. G. Wallin
Reduced Heart Rate Variability After Right-Sided Stroke
Stroke, February 1, 1996; 27(2): 247 - 251.
[Abstract] [Full Text]

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 Arch NeurolHome page
M. Koepp, A. Kern, and D. Schmidt
Electrocardiographic Changes in Patients With Brain Tumors
Arch Neurol, February 1, 1995; 52(2): 152 - 155.
[Abstract] [PDF]


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