Lateralization in autonomic dysfunction in ischemic stroke involving the insular cortex

Neuroreport. 2004 Feb 9;15(2):357-61. doi: 10.1097/00001756-200402090-00029.


Autonomic nervous system dysfunction is a common complication of ischemic stroke. Clinical and experimental data indicate hemispheric lateralization in the control of autonomic activity. The insular cortex has also been shown to play a crucial role in the central autonomic network. The aim of this study was to assess cardio-autonomic dysfunction in patients with ischemic insular versus non-insular cortex infarction, and to demonstrate a possible lateralization in autonomic activity mediated by the insular cortex. Sympathetic function was prospectively assessed by determining plasma norepinephrine and epinephrine in 15 patients with left-hemisphere (LH; four insular infarction), and 14 with right-hemisphere (RH) middle cerebral artery (MCA) stroke (five insular infarction). Systolic and diastolic blood pressure and heart rate were recorded during the first 5 days after stroke. Sympathetic activity was significantly higher in insular than in non-insular infarction (p < 0.05) with concomitantly elevated cardiovascular parameters in insular stroke patients. The pathological activation of the sympathetic nervous system was most excessive in RH-stroke involving the insular cortex (p < 0.05). Our data indicate a hemispheric lateralization in autonomic activity which is mediated by the right-sided insular cortex. Patients with RH stroke involving the insular cortex are most susceptible to develop cardio-autonomic dysfunction.

MeSH terms

  • Aged
  • Autonomic Nervous System Diseases / etiology
  • Autonomic Nervous System Diseases / pathology
  • Autonomic Nervous System Diseases / physiopathology*
  • Blood Pressure / physiology
  • Brain Ischemia / complications*
  • Causality
  • Cerebral Cortex / pathology
  • Cerebral Cortex / physiopathology*
  • Cerebral Infarction / blood
  • Cerebral Infarction / pathology
  • Cerebral Infarction / physiopathology
  • Epinephrine / blood
  • Functional Laterality / physiology*
  • Heart Rate / physiology
  • Humans
  • Infarction, Middle Cerebral Artery / complications
  • Middle Aged
  • Nordefrin / blood
  • Prospective Studies
  • Stroke / complications*


  • Nordefrin
  • Epinephrine