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Journal of Neurology, Neurosurgery, and Psychiatry 2006;77:813; doi:10.1136/jnnp.2006.093468
Copyright © 2006 by the BMJ Publishing Group Ltd.
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EDITORIAL COMMENTARY
Changes in insular infarcts

Cardiovascular and metabolic changes in insular infarcts: a delayed phenomenon?

M Pasquini1,2, D Leys1

1 Department of Neurology, Stroke Unit, Lille University Hospital, Lille, France
2 Department of Neurology, University "La Sapienza", Rome, Italy

Correspondence to:
Correspondence to:
M Pasquini
Department of Neurology (EA2691), Lille University Hospital, F-59037 Lille, France; marta.pasquini@uniroma1.it

Aggressive monitoring of electrocardiogram, blood pressure and blood glucose levels after 72 h in patients with insular infarcts is crucial in identifying whether they are prone to develop arrhythmias, hyperglycaemia and hypertension after the onset of stroke.

The first 150 words of the full text of this article appear below.

Infarction of the insular cortex may be associated with autonomic sympathetic activation, leading to repolarisation changes and arrhythmias.1 Moreover, the involvement of the insular cortex in the infarct area has been reported to be associated with a higher frequency of hyperglycaemia, and this association does not depend on the volume of the lesion, or pre-existing diabetes mellitus.2 Patients with insular infarcts also show a marked increase in nocturnal blood pressure, and higher serum norepinephrine concentrations.3 By contrast, in the article by Pettersen et al4(see p 885), insular infarcts are not associated with higher levels of blood pressure or serum glucose. How may one reconcile these differences?

The Pettersen study does have a methodological limitation: as all the patients underwent thrombolytic treatment, patients with systolic blood pressure higher than 180 mm Hg or blood glucose levels higher than 8.88 mmol/l were excluded. This limitation, . . . [Full text of this article]


Relevant Article

Insular cortical ischaemia does not independently predict acute hypertension or hyperglycaemia within 3 h of onset
J A Pettersen, J H W Pexman, P A Barber, A M Demchuk, A M Buchan, and M D Hill
J. Neurol. Neurosurg. Psychiatry 2006 77: 885-887. [Abstract] [Full Text] [PDF]





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