Lateralized periodic discharges in insular status epilepticus: A case report of a periodic EEG pattern associated with ictal manifestation

Russo, Mirella; Carrarini, Claudia; Stefano, Vincenzo Di; Nanni, Stefania; Ferrante, Camilla; Onofrj, Marco; Anzellotti, Francesca

doi:10.1016/j.cnp.2019.01.002

Cited by 4 publications

(2 citation statements)

References 11 publications

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“…The insular cortex is considered a "hub" interconnecting several networks [1,2] and contributing to motor and multimodal sensorial and cognitive functions [3,4], and our knowledge comes from research using animal models, brain stimulation and functional magnetic resonance imaging (MRI) [1]. In addition, insular function has been the object of several studies in healthy volunteers and in the context of neurodegenerative [5], tumours [6] and cerebrovascular diseases [1]. Focal ischemic lesions restricted to the insular cortex (insular stroke, IS) are rare, because of the frequent involvement of adjacent brain regions sharing common vascular supply [7].…”

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confidence: 99%

Clinical presentation of strokes confined to the insula: a systematic review of literature

et al. 2021

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Background and purpose The insular cortex serves a wide variety of functions in humans, ranging from sensory and affective processing to high-level cognition. Hence, insular dysfunction may result in several different presentations. Ischemic strokes limited to the insular territory are rare and deserve a better characterization, to be quickly recognized and to receive the appropriate treatment (e.g. thrombolysis). Methods We reviewed studies on patients with a first-ever acute stroke restricted to the insula. We searched in the Medline database the keywords “insular stroke” and “insular infarction”, to identify previously published cases. Afterwards, the results were divided depending on the specific insular region affected by the stroke: anterior insular cortex (AIC), posterior insular cortex (PIC) or total insula cortex (TIC). Finally, a review of the clinical correlates associated with each region was performed. Results We identified 25 reports including a total of 49 patients (59.7 ± 15.5 years, 48% male) from systematic review of the literature. The most common clinical phenotypes were motor and somatosensory deficits, dysarthria, aphasia and a vestibular-like syndrome. Atypical presentations were also common and included dysphagia, awareness deficits, gustatory disturbances, dysautonomia, neuropsychiatric or auditory disturbances and headache. Conclusions The clinical presentation of insular strokes is heterogeneous; however, an insular stroke should be suspected when vestibular-like, somatosensory, speech or language disturbances are combined in the same patient. Further studies are needed to improve our understanding of more atypical presentations.

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Section: Introductionmentioning

confidence: 99%

Clinical presentation of strokes confined to the insula: a systematic review of literature

et al. 2021

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“…Only a few case reports exist, typically describing LPDs which can be seen in conjunction with electrographic seizures. 1,2,[14][15][16] In this case series, we report the association of LRDA with acute insular lesions in patients with infectious and autoimmune encephalitis who developed acute seizures. The insular cortex, which is increasingly recognized as an area from which seizures arise, 7 is located deep within the sylvian fissure and covered by the fronto-parieto-temporal operculum.…”

Section: Discussionmentioning

confidence: 94%

Lateralized Rhythmic Delta Activity in Patients With Infectious or Autoimmune Insular Lesions

Husari

Ritzl

2020

Clin EEG Neurosci

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Introduction Lateralized rhythmic delta activity (LRDA) is a rare pattern on the ictal-interictal continuum (IIC) encountered in critically ill patients. Its association with acute seizures is yet to be fully explored. Insular involvement is a common finding in patients with infectious and autoimmune encephalitis. The association between acute insular lesions and the ictal-interictal continuum, particularly LRDA, has not been explored before. Methods A case series of 4 patients with either herpetic or autoimmune encephalitis and prominent insular cortex involvement who had LRDA when monitored on continuous EEG is being presented. Results Two patients had herpetic encephalitis and 2 patients had autoimmune encephalitis. All patients had either clinical or electrographic seizures with 1 patient progressing into new-onset refractory status epilepticus. Conclusion LRDA can be seen in patients with insular cortex acute inflammation. In this group of patients, LRDA may be associated with a higher risk of acute seizures. The presence of this otherwise not clearly epileptiform pattern should raise the clinical suspicion for the development of acute seizures. Patients with LRDA and ipsilateral insular lesions should be carefully monitored for the development of recurrent electrographic or electroclinical seizures and status epilepticus.

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Common Abnormal EEG in Neurocritical Ill Patients

Wang

et al. 2021

Multi-Modal EEG Monitoring of Severely Neurologically Ill Patients

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Lateralized periodic discharges in insular status epilepticus: A case report of a periodic EEG pattern associated with ictal manifestation

Cited by 4 publications

References 11 publications

Clinical presentation of strokes confined to the insula: a systematic review of literature

Clinical presentation of strokes confined to the insula: a systematic review of literature

Lateralized Rhythmic Delta Activity in Patients With Infectious or Autoimmune Insular Lesions

Common Abnormal EEG in Neurocritical Ill Patients

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