Social-emotional dysfunction after isolated right anterior insular infarction

Abstract

Recent human functional neuroimaging studies have demonstrated intrinsic functional connectivity among the anterior insula (AI), anterior cingulate cortex (ACC), amygdala, thalamus, hypothalamus, striatum, and brainstem. These regions have been collectively referred to as the ''salience network'' due to their consistent activation by diverse, homeostatically relevant stimuli that carry emotional weight [8]. Evidence supporting a role for the salience network in social-emotional function comes from patients with behavioral variant frontotemporal dementia (bvFTD), an early age-of-onset neurodegenerative disorder that produces dramatic changes in social behavior [6,7]. The right ventral anterior insula, a focus of degeneration in bvFTD, has been proposed as a key hub within this network [9], and functional imaging studies reveal consistent activation of this region during social-emotional processing [3]. The consequences of isolated, destructive anterior insula lesions, however, have not been reported. Here, we describe a 66-year-old woman who developed an abrupt change in social behavior after isolated right ventral anterior insular infarction.A 66-year-old right-handed woman presented with sudden onset of slurred speech. She had suffered from hypertension for 3 years and had a history of ischemic stroke involving the left parietal cortex, manifested by a subjective dysarthria one-and-a-half years earlier, from which she completely recovered during the follow-up period. She had been taking an antiplatelet agent and had no history of alcohol use or smoking. She had no previous history of depression or other psychiatric illness. Neurological examination revealed mild dysarthria and left central facial weakness. Diffusion-weighted magnetic resonance imaging (MRI) on the same day of admission revealed focal hyperintensity in the ventral anterior portion of the right insular cortex (Fig. 1a, b), with a corresponding hypointensity on the apparent diffusion coefficient map. T2-weighted imaging showed no abnormalities. Single photon emission computed tomography (SPECT) performed 2 days post-stroke showed hypoperfusion in the same region (Fig. 1c), but also in distributed right anterior brain structures (temporal pole, striatum, lateral frontal cortex) with known connectivity to the AI. Magnetic Electronic supplementary material The online version of this article (

Multidimensional assessment of empathic abilities in patients with insular glioma

“…However, we did not find that the insula patients were damaged in their basic cognitive and intelligence functions when tested by MoCA and Raven's Standard Progressive Matrices. A previous case study reported that a patient demonstrated significant personality changes immediately after an isolated right AI infarction (Cho et al, 2012), whereas our results with the NEO-FiveFactor Inventory suggest that the personality of insula patients do not change than for control groups. The present study also revealed no significant differences in AE and CE between the lesion and healthy control groups, thereby implying that intracranial hypertension and mentality changes that are caused by disease may not have an effect on empathy.…”

Impaired Emotion Recognition after Left Hemispheric Stroke: A Case Report and Brief Review of the Literature

“…In this case, an impaired recognition of all negative emotions was found. Another study reported on a patient with behavioral changes after an isolated stroke of the anterior part of the right insula [37]. Although emotion perception was not assessed, an additional SPECT scan showed hypoperfusion in several right anterior brain structures, most of which are thought to be involved in an emotion-network.…”

Von Economo Neurons and Fork Cells: A Neurochemical Signature Linked to Monoaminergic Function

“…In humans, the ACC and FI are important hubs within a large-scale network that processes homeostatically salient information (Seeley et al 2007;Touroutoglou et al 2012;Zhou and Seeley 2014). Engagement of these hubs increases with noradrenergic (Hermans et al 2011) and autonomic nervous system activation (Critchley and Harrison 2013), and focal vascular or degenerative lesions to ACC and FI are associated with social, emotional, and autonomic deficits (Bush et al 2000;Zhou et al 2010;Cho et al 2012). Further studies are needed to determine how ADRA1A expression relates to VENs and fork cell functioning within the network hubs where these cells reside.…”