Neurology 2002;59:1950-1955
© 2002 American Academy of Neurology
Strokes restricted to the insular cortex
C. Cereda, MD,
J. Ghika, MD,
P. Maeder, MD and
J. Bogousslavsky, MD
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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