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Isolated Insular Stroke: Clinical Presentation.

Fabrizio Giammello1, Domenico Cosenza1, Carmela Casella2

  • 1U.O.S.D. Stroke Unit, Department of Clinical and Experimental Medicine, AOU Policlinico G. Martino, University of Messina, Messina, Italy.

Cerebrovascular Diseases (Basel, Switzerland)
|February 6, 2020
PubMed
Summary

Isolated insular stroke (IIS) presents with diverse neurological deficits, including motor, sensory, and cognitive impairments. Continuous cardiac monitoring is crucial as atrial fibrillation may follow insular infarction.

Keywords:
Autonomic activation after strokeInsular strokeNeurointensive careStroke diagnostics

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Area of Science:

  • Neurology
  • Neuroscience
  • Cardiology

Background:

  • Insular ischemia is often studied in stroke patients but frequently involves adjacent brain structures.
  • The insula's vulnerability to ischemia stems from its vascular anatomy, particularly the middle cerebral artery (MCA) M1 and M2 segments.
  • Atrial fibrillation (AF) is a potential cause of embolic occlusion in the insular territory.

Purpose of the Study:

  • To characterize the clinical features of first-ever acute ischemic strokes in the insular territory.
  • To specifically investigate atypical manifestations of isolated insular stroke (IIS).

Main Methods:

  • Retrospective analysis of 233 first-ever insular territory stroke patients from a stroke registry (2014-2018).
  • Identification of 13 cases with isolated insular stroke (IIS) confirmed by CT/MRI lesions restricted to the insula.
  • Exclusion of patients with coexisting neurological diseases, structural brain lesions, or extensive subinsular involvement (>50%).

Main Results:

  • 13 patients with IIS were identified (mean age 74 years).
  • IIS manifested with a combination of typical and atypical symptoms, including motor, somatosensory, speech, coordination, autonomic, and cognitive disturbances.
  • A high frequency of cardiac disturbances, including potential short-duration AF following the stroke, was observed.

Conclusions:

  • Isolated insular stroke presents with a wide spectrum of neurological deficits.
  • The study highlights the importance of continuous cardiac monitoring in IIS patients due to the risk of subsequent AF.
  • Further research is needed to define the incidence and precise clinical implications of IIS.