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Review
. 2024 Dec;34(6):549-560.
doi: 10.1007/s10286-024-01066-9. Epub 2024 Sep 24.

The insular cortex, autonomic asymmetry and cardiovascular control: looking at the right side of stroke

Marco Antônio Peliky Fontes  1 , Liliane Ramos Dos Santos Machado  2 , Ana Clara Rocha Viana  2 , Matheus Henrique Cruz  2 , Ícaro Santos Nogueira  2 , Marcela Gondim Lima Oliveira  2 , Christiane Braga Neves  2 , Ana Caroline Ventris Godoy  2 , Luke A Henderson  3 , Vaughan G Macefield  4   5
Affiliations
Review

The insular cortex, autonomic asymmetry and cardiovascular control: looking at the right side of stroke

Marco Antônio Peliky Fontes et al. Clin Auton Res. 2024 Dec.

Abstract

Purpose: Evidence from animal and human studies demonstrates that cortical regions play a key role in autonomic modulation with a differential role for some brain regions located in the left and right brain hemispheres. Known as autonomic asymmetry, this phenomenon has been demonstrated by clinical observations, by experimental models, and currently by combined neuroimaging and direct recordings of sympathetic nerve activity. Previous studies report peculiar autonomic-mediated cardiovascular alterations following unilateral damage to the left or right insula, a multifunctional key cortical region involved in emotional processing linked to autonomic cardiovascular control and featuring asymmetric characteristics.

Methods: Based on clinical studies reporting specific damage to the insular cortex, this review aims to provide an overview of the prognostic significance of unilateral (left or right hemisphere) post-insular stroke cardiac alterations. In addition, we review experimental data aiming to unravel the central mechanisms involved in post-insular stroke cardiovascular complications.

Results and conclusion: Current clinical and experimental data suggest that stroke of the right insula can present a worse cardiovascular prognosis.

Keywords: Asymmetry; Cardiovascular; Dorsomedial hypothalamus; Insular cortex; Stroke.

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