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Insula stroke: the weird and the worrisome
  1. Ashley Laurence Bharat Raghu1,
  2. Tariq Parker1,
  3. André van Wyk2,
  4. Alexander Laurence Green1,3
  1. 1 Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
  2. 2 Acute Stroke Unit, Royal Berkshire Hospital, Reading, UK
  3. 3 Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
  1. Correspondence to Ashley Laurence Bharat Raghu, Nuffield Department of Surgical Sciences, University of Oxford, Oxford OX1 2JD, UK; ashley.raghu{at}


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.

  • stroke
  • brain infarction
  • infarction, middle cerebral artery
  • insular cortex

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  • Contributors All authors contributed to revising the manuscript critically for important intellectual content, approved the final version of the manuscript, and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy and integrity of any part of the work are appropriately investigated and resolved. ALG and ALBR (last and first authors, respectively) contributed the greater part of drafting the manuscript and are responsible for its original inception and formal literature search. Mr Jon Owen (not an author) was commissioned for the artwork of figure 1.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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