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Infarction of the insula is a common scenario with large tissue-volume strokes in the middle cerebral artery territory. Considered to be part of the central autonomic network, infarction of this region is associated with autonomic disturbances, in particular cardiovascular dysregulation. Risk of aspiration following stroke is also associated with involvement of the insula, consistent with its purported participation in complex functions of the mouth and pharynx. Strokes restricted to the insula are rare and present with a broad range of symptoms that offer a window of insight into the diverse functionality of the insular cortex. Chemosensory, autonomic, vestibular, auditory, somatosensory, language and oropharyngeal functional deficits are all recognised, among others. Long-term sequelae are unknown but profound symptoms, such as hemiparesis, are usually transient. Understanding the patterns of dysfunction highlighted provides the basis for future strategies to optimise stroke management on the discovery of insula involvement.

Original publication

DOI

10.1136/postgradmedj-2019-136732

Type

Journal article

Journal

Postgrad Med J

Publication Date

09/2019

Volume

95

Pages

497 - 504

Keywords

brain infarction, infarction, middle cerebral artery, insular cortex, stroke, Autonomic Nervous System Diseases, Cardiovascular Diseases, Cerebral Cortex, Humans, Language Disorders, Somatosensory Disorders, Stomatognathic Diseases, Stroke, Vestibular Diseases