Loss of insular ribbon - sign of early MCA infarction

Case contributed by Dr Nafisa Shakir Batta


Presented with right sided weakness. history of previous stroke episode

Patient Data

Age: 70
Gender: Male

CT done immediately from triage

    CT reveals a subtle hypodensity at the left insular cortex , with preserved attenuation of the lentiform nucleus. An older subacute infarct is evident at the right posterior perirolandic region of pareital cortex.


CT after two hours ( post thrombolysis)

Post thrombolysis delayed two hour scans showed a more mature infarct in the left perisylvian  cortex, clearly depicting the 'loss of insular ribbon sign'. Also notable is the straightening of the Sylvian sulcus, which may be seen occassionally.

Corroborative MRI confirms the restriction of diffusion in the left isular cortex. The right subacute infarct shows minimal persistent bright signal on DWI.

Case Discussion

Loss of insular ribbon sign denotes loss of grey white matter distinction at the insular cortex secondary to edema due to an ischaemic insult. This is an early sign of MCA infarction and should be looked for intently in the clinical setting of stroke.


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Case information

rID: 26343
Published: 14th Dec 2013
Last edited: 25th Jan 2016
Inclusion in quiz mode: Included

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