Circulatory shock associated with left insular stroke and chronic steroid treatment

BACKGROUND

Damage to the insula has been associated with various types of cardiovascular dysfunction, including arrhythmias and blood pressure imbalances. Acute neuroendocrine disturbances following insular damage have also been described.

CASE PRESENTATION

A 50-year-old right-handed man with a left insular ischemic lesion exhibited aphasia and right central VII nerve palsy. Five days after the stroke, the patient exhibited severe bradycardia and hypotension. He had been treated for ocular trauma with prednisone for the preceding 3 weeks. Cortisol and adrenocorticotropic hormone levels indicated secondary adrenal insufficiency. Despite adequate fluid intake, the patient's blood pressure dropped, requiring norepinephrine administration. Midodrine was also initiated, leading to clinical improvement. The therapy was gradually discontinued as vital signs normalized. By Day 24, electrocardiogram monitoring was unremarkable, hormonal levels normalized, and the neurological examination revealed only mild residual speech fluency impairment. Computed tomography scans confirmed a recovering ischemic lesion of the left insula.

CONCLUSIONS

This case reveals the inhibitory effect exerted by a left-sided insular stroke on the autonomic system. It also highlights the still largely unexplored neuroendocrine complications of damage to this brain region.

Effective Connectivity in the Human Brain for Sour Taste, Retronasal Smell, and Combined Flavour

The anterior insula and rolandic operculum are key regions for flavour perception in the human brain; however, it is unclear how taste and congruent retronasal smell are perceived as flavours. The multisensory integration required for sour flavour perception has rarely been studied; therefore, we investigated the brain responses to taste and smell in the sour flavour-processing network in 35 young healthy adults. We aimed to characterise the brain response to three stimulations applied in the oral cavity—sour taste, retronasal smell of mango, and combined flavour of both—using functional magnetic resonance imaging. Effective connectivity of the flavour-processing network and modulatory effect from taste and smell were analysed. Flavour stimulation activated middle insula and olfactory tubercle (primary taste and olfactory cortices, respectively); anterior insula and rolandic operculum, which are associated with multisensory integration; and ventrolateral prefrontal cortex, a secondary cortex for flavour perception. Dynamic causal modelling demonstrated that neural taste and smell signals were integrated at anterior insula and rolandic operculum. These findings elucidated how neural signals triggered by sour taste and smell presented in liquid form interact in the brain, which may underpin the neurobiology of food appreciation. Our study thus demonstrated the integration and synergy of taste and smell.

The 100 Most Cited Papers Concerning the Insular Cortex of the Brain: A Bibliometric Analysis

Background: The insula is one of the most researched brain regions with many highly cited papers. However, unlike the literature of other fields, there is currently no study that has identified the 100 most cited papers within the literature of the insula. The aim of the current study was to fill in the knowledge gap by determining which publications concerning the insula have been cited most often, who contributed to them, and what topics they were dealing with. Methods: The Web of Science online database was searched to identify the 100 most cited publications mentioning the insular cortex in their titles, abstracts or keywords. To systematically exclude irrelevant publications, the search strategy was finalized as: TS = (insula OR insular OR "island of Reil") NOT TS = ("insular biogeography" OR "insular mammal*" OR "*insular lymphatic*") NOT WC = ("Geochemistry and Geophysics" OR "Ecology"). The identified publications were sorted in descending order of citation count. The 100 most cited publications concerning the insula of the brain were identified and their bibliometric data was extracted and assessed. The VOSviewer software was used with default parameters to generate a bubble map that analyzes and visualizes the words/phrases used in the titles and abstracts of the publications. Results: There were 67 articles on experiments/lab studies and 33 meta-analyses/reviews but no opinion or methods paper. They had an average of 943.4 citations (or 62.9 citations per year), 93.5 references and 13.4 pages. There were 35 papers published in open access. USA was the major contributing country. The most top-ranked publications were concerning emotion, salience and pain. Conclusion: Two-thirds of the publications concerned the normal brain function/mechanism (n = 67), whereas 20 publications concerned disease/therapeutic intervention and another 13 concerned normal anatomy. For the 67 original articles, 57 used human subjects whereas 10 used animal models. MRI was the commonest modality (n = 37), followed by PET (n = 16). Nine articles investigated by histology, two by multiple modalities and three by other modality.