Fink John N, Selim Magdy H, Kumar Sandeep, Voetsch Barbara, Fong Wing Chi, Caplan Louis R
Department of Medicine, Christchurch School of Medicine and Health Sciences, Christchurch, New Zealand.
Arch Neurol. 2005 Jul;62(7):1081-5. doi: 10.1001/archneur.62.7.1081.
Insula infarction is an early computed tomographic sign of middle cerebral artery (MCA) territory stroke and may affect cardiovascular autonomic function.
To determine insula involvement in MCA territory infarction and its relationship with infarcts in the remainder of the MCA territory, stroke severity, and clinically relevant cardiovascular conditions.
Case series (August 1, 1997, to June 30, 2000).
Academic stroke center.
A total of 150 consecutive patients with nonlacunar MCA territory stroke who underwent magnetic resonance imaging within 48 hours of stroke onset.
Association of insula infarction with the National Institutes of Health Stroke Scale (NIHSS) score, location of vascular occlusion, and cardiovascular events.
Insular lesions were present in 72 patients (48%); 34 (23%) had major insular lesions and 38 (25%) had minor lesions. Insula infarction was associated with lenticulostriate territory infarction (46% vs 14%; P<.001), more than one third of MCA territory infarction (35% vs 3%; P<.001), higher NIHSS score (13.5 vs 6; P<.001), and proximal vascular occlusion detected on magnetic resonance angiography. These associations were strongest for patients with major insular lesions. Clinically significant new arrhythmia was present in 15 of 72 with insula infarction (13 atrial fibrillations) and 4 of 78 without (P = .06). Insula infarction was associated with lower diastolic blood pressure at admission but was not associated with pulse rate, QTc interval, myocardial infarction, or sudden death.
The insular cortex is involved in almost half of patients with nonlacunar ischemic MCA territory strokes. Major insula involvement is associated with large MCA territory infarcts, proximal MCA occlusions, and greater stroke severity. Insula infarction was not a predictor of clinically significant acute cardiovascular events during hospital stay in our patients.
岛叶梗死是大脑中动脉（MCA）供血区卒中的早期计算机断层扫描征象，可能影响心血管自主功能。
确定岛叶梗死在MCA供血区梗死中的情况及其与MCA供血区其余部位梗死、卒中严重程度和临床相关心血管疾病的关系。
病例系列研究（1997年8月1日至2000年6月30日）。
学术性卒中中心。
共150例非腔隙性MCA供血区卒中患者，在卒中发作后48小时内接受了磁共振成像检查。
岛叶梗死与美国国立卫生研究院卒中量表（NIHSS）评分、血管闭塞部位及心血管事件的相关性。
72例患者（48%）存在岛叶病变；34例（23%）有主要岛叶病变，38例（25%）有轻微病变。岛叶梗死与豆纹动脉供血区梗死相关（46%对14%；P<0.001），超过三分之一的MCA供血区梗死（35%对3%；P<0.001），NIHSS评分更高（13.5对6；P<0.001），且磁共振血管造影显示近端血管闭塞。这些关联在有主要岛叶病变的患者中最为明显。72例岛叶梗死患者中有15例出现具有临床意义的新发心律失常（13例房颤），78例无岛叶梗死患者中有4例出现（P = 0.06）。岛叶梗死与入院时舒张压较低相关，但与脉搏率、QTc间期、心肌梗死或猝死无关。
近半数非腔隙性缺血性MCA供血区卒中患者存在岛叶皮质受累。主要岛叶受累与大面积MCA供血区梗死、MCA近端闭塞及更严重的卒中相关。在我们的患者中，岛叶梗死并非住院期间具有临床意义的急性心血管事件的预测因素。
