Kuris Fedra, Tartaglia Sara, Sperotto Roberto, Ceccarelli Laura, Bagatto Daniele, Lorenzut Simone, Merlino Giovanni, Janes Francesco, Gentile Carolina, Marinig Roberto, Verriello Lorenzo, Valente Mariarosaria, Pauletto Giada
Clinical Neurology Unit, Head-Neck and NeuroScience Department Udine, Udine University Hospital, Udine, Italy.
Division of Neuroradiology, Diagnostic Imaging Department, Udine University Hospital, Udine, Italy.
Front Neurol. 2024 Feb 29;15:1332382. doi: 10.3389/fneur.2024.1332382. eCollection 2024.
Isolated insular strokes (IIS) are a rare occurrence due to the frequent concomitant involvement of adjacent territories, supplied by the M2 segment of the middle cerebral artery (MCA), and clinical aspects are sometimes contradictory. We aimed to describe clinical and radiological characteristics of a pure IIS case series, focusing on its functional outcome and cardiac involvement.
We identified 15 isolated insular ischemic strokes from a pool of 563 ischemic strokes occurred between January 2020 and December 2021. Data collection consisted of demographic and baseline clinical characteristics, comorbidities, electrocardiograms, echocardiograms, stroke topography and etiology, reperfusive treatments, and outcome measures. Descriptive statistical analysis was carried out.
Newly detected cardiovascular alterations were the prevalent atypical presentation. Cardioembolism was the most frequent etiology. Most of patients had major neurological improvement at discharge and good outcome at 3-months follow-up.
IIS are extremely rare, representing according to our study about 2.6% ischemic strokes cases per year, and patients have peculiar clinical manifestations, such as dysautonomia and awareness deficits. Our data suggest the possibility for these patients to completely recover after acute ischemic stroke notwithstanding the pivotal role of the insula in cerebral connections and the frequent association with MCA occlusion. Moreover, given the central role of the insula in regulating autonomic functions, newly detected cardiac arrhythmias must be taken into consideration, as well as a full diagnostic work-up for the research of cardioembolic sources. To our knowledge, this is the largest monocentric case series of IIS and it might be useful for future systematic reviews.
由于大脑中动脉（MCA）M2段供血的相邻区域常同时受累，孤立性岛叶卒中（IIS）较为罕见，其临床症状有时相互矛盾。我们旨在描述一组单纯IIS病例的临床和影像学特征，重点关注其功能转归和心脏受累情况。
我们从2020年1月至2021年12月发生的563例缺血性卒中病例中识别出15例孤立性岛叶缺血性卒中。数据收集包括人口统计学和基线临床特征、合并症、心电图、超声心动图、卒中部位及病因、再灌注治疗和转归指标。进行描述性统计分析。
新发现的心血管改变是主要的非典型表现。心源性栓塞是最常见的病因。大多数患者出院时神经功能有显著改善，3个月随访时预后良好。
IIS极为罕见，根据我们的研究，每年约占缺血性卒中病例的2.6%，患者有特殊的临床表现，如自主神经功能障碍和意识缺陷。我们的数据表明，尽管岛叶在脑连接中起关键作用且常与MCA闭塞相关，但这些患者在急性缺血性卒中后仍有可能完全康复。此外，鉴于岛叶在调节自主神经功能中的核心作用，必须考虑新发现的心律失常，以及对心源性栓子来源进行全面的诊断检查。据我们所知，这是最大的单中心IIS病例系列，可能对未来的系统评价有用。
