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From the Department of Neurology, CHUV, Lausanne, Switzerland.
Address correspondence and reprint requests to Dr. J. Ghika, Department of Neurology, CHUV, BH 13, CH-1011 Lausanne, Switzerland; e-mail: joseph.ghika{at}chuv.hospvd.ch
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).
Conclusion: 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.
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