Acute Stroke of the Insular Cortex Leading to Heart Failure

Isaac Akkad, Suhali Kundu, Avraham Miller, Jyothi Ramachandran, Vijay Shetty


In humans, the limbic and paralimbic systems, including the insular cortex, are the central autonomic networks responsible for maintaining cardiovascular autonomic control. The right insular cortex plays a predominant role in establishing sympathetic tone while the left insular cortex in establishing parasympathetic tone of the heart. Disturbances in the autonomic system due to cerebrovascular diseases, such as an ischemic stroke in the territory of the middle cerebral artery, could lead to impairment in the cardiovascular balance, consequently increasing the incidence of tachyarrhythmia. Abnormalities of cardiovascular autonomic control may retain prognostic relevance, as they have been associated with adverse clinical outcomes after stroke. Acute ischemic stroke has been shown to increase the rate of cardiac-related mortality as a pathophysiological consequence of an acute stress response in patients with no cardiovascular comorbidities due to the dysfunction of the brain-heart axis. This case report highlights an instance when this axis was disturbed leading to non-ischemic cardiomyopathy.

J Med Cases. 2016;7(3):94-97


Acute stroke; Heart failure; Insular cortex; Non-ischemic cardiomyopathy; Parasympathetic system; Sympathetic system; Right middle cerebral artery

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