Kodumuri Nishanth, Sebastian Rajani, Davis Cameron, Posner Joseph, Kim Eun Hye, Tippett Donna C, Wright Amy, Hillis Argye E
NTR University of Health Sciences, Osmania Medical College, Hyderabad, Telangana 500095, India; Department of Neurology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287, USA.
Department of Neurology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287, USA.
Neuroimage Clin. 2016 Jan 12;11:41-45. doi: 10.1016/j.nicl.2016.01.007. eCollection 2016.
The insula has been implicated in many sequelae of stroke. It is the area most commonly infarcted in people with post-stroke arrhythmias, loss of thermal sensation, hospital acquired pneumonia, and apraxia of speech. We hypothesized that some of these results reflect the fact that: (1) ischemic strokes that involve the insula are larger than strokes that exclude the insula (and therefore are associated with more common and persistent deficits); and (2) insular involvement is a marker of middle cerebral artery (MCA) occlusion. We analyzed MRI scans of 861 patients with acute ischemic hemispheric strokes unselected for functional deficits, and compared infarcts involving the insula to infarcts not involving the insula using t-tests for continuous variables and chi square tests for dichotomous variables. Mean infarct volume was larger for infarcts including the insula (n = 232) versus excluding the insula (n = 629): 65.8 ± 78.8 versus 10.2 ± 15.9 cm(3) (p < 0.00001). Even when we removed lacunar infarcts, mean volume of non-lacunar infarcts that included insula (n = 775) were larger than non-lacunar infarcts (n = 227) that excluded insula: 67.0 cm(3) ± 79.2 versus 11.5 cm(3) ± 16.7 (p < 0.00001). Of infarcts in the 90th percentile for volume, 87% included the insula (χ(2) = 181.8; p < 0.00001). Furthermore, 79.0% infarcts due to MCA occlusion included the insula; 78.5% of infarcts without MCA occlusion excluded the insula (χ(2) = 93.1; p < 0.0001). The association between insular damage and acute or chronic sequelae likely often reflects the fact that insular infarct is a marker of large infarcts caused by occlusion of the MCA more than a specific role of the insula in a range of functions. Particularly in acute stroke, some deficits may also be due to ischemia of the MCA or ICA territory caused by large vessel occlusion.
岛叶与中风的许多后遗症有关。在中风后出现心律失常、热感觉丧失、医院获得性肺炎和言语失用症的患者中，岛叶是最常发生梗死的区域。我们推测，其中一些结果反映了以下事实：（1）累及岛叶的缺血性中风比未累及岛叶的中风更大（因此与更常见和持续的缺陷相关）；（2）岛叶受累是大脑中动脉（MCA）闭塞的一个标志。我们分析了861例未因功能缺陷而被挑选的急性缺血性半球中风患者的MRI扫描结果，并使用连续变量的t检验和二分变量的卡方检验，比较了累及岛叶的梗死灶和未累及岛叶的梗死灶。包括岛叶的梗死灶（n = 232）的平均梗死体积大于不包括岛叶的梗死灶（n = 629）：65.8±78.8 vs 10.2±15.9 cm³（p < 0.00001）。即使我们去除腔隙性梗死，包括岛叶的非腔隙性梗死灶（n = 775）的平均体积也大于不包括岛叶的非腔隙性梗死灶（n = 227）：67.0 cm³±79.2 vs 11.5 cm³±16.7（p < 0.00001）。在体积处于第90百分位的梗死灶中，87%包括岛叶（χ² = 181.8；p < 0.00001）。此外，由于MCA闭塞导致的梗死灶中有79.0%包括岛叶；没有MCA闭塞的梗死灶中有78.5%不包括岛叶（χ² = 93.1；p < 0.0001）。岛叶损伤与急性或慢性后遗症之间的关联可能常常反映出这样一个事实，即岛叶梗死是由MCA闭塞引起的大面积梗死的一个标志，而不是岛叶在一系列功能中的特定作用。特别是在急性中风中，一些缺陷也可能是由于大血管闭塞导致的MCA或ICA区域缺血所致。
