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Background: the insula has been the object of few studies and case reports, but the incidence of insular strokes (IS) is not well defined, due to its rarity. Symptoms from IS appear heterogeneous and unusual presentations are common. The aim of our study is to characterize the clinical presentation of acute ischemic IS with specific attention to unusual symptoms. Methods: IS patients were enrolled from the Stroke Unit of the “SS. Annunziata” Hospital of Chieti and “SS. Salvatore” Hospital of L’Aquila, among 1252 with a first-event acute stroke in a period of 4 years. IS patients presented lesions restricted to the insular region on neuroimaging. Complete neuropsychological and neuropsychiatric assessment was performed in 21 of 38 patients. Results: we identified 38 patients, 18 with right IS and 20 with left IS. IS patients presented at onset with one or a combination of behavioral symptoms. Among atypical symptoms psychiatric disturbances, vestibular-like syndrome, consciousness disturbances or impaired vigilance, transient dysphagia were reported. From neuropsychiatric assessment (from 21 patients), resulted a significant difference in score of neuropsychological and psychiatric scales between left and right-side insular strokes and in score of hostility between antierior-posterior lesion respect to more-extended lesions involving all the insula. Conclusions: Sensory-motor deficits, aphasia, dysarthria and transient dysphagia are the most typical presentations of IS among described symptoms; in addition, we observed many unusual clinical presentations, such as dizziness, autonomic dysfunction, gustatory and auditory disturbances. These symptoms give a minimum score to the common severity and disability scales used in stroke units (NIHSS, mRS); on the other hand, atypical symptoms do not take any points on NIHSS, thus contributing to the underestimation of the IS.

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© Copyright 2019 Morressier GmbH. All rights reserved.

© Copyright 2019 Morressier GmbH.
All rights reserved.