Loss of the insular ribbon sign

Case contributed by Dario Giambelluca


Acute right side weakness.

Patient Data

Age: 85 years
Gender: Male

CT done immediately from triage


CT scan performed a few hours after the onset of the symptoms revealed loss of definition of the grey-white interface in the lateral margin of the left insular cortex ("insular ribbon"), strongly suspected for middle cerebral artery (MCA) strokes.

Follow-up CT scan at 24 hours


Follow-up CT scan, performed 24 hours after the first exam, revealed a wide area of hypodensity in the left frontal, parietal and temporal lobe, the consequence of a recent ischemic vascular event of the territory of left MCA, with mass effect on the adjacent ventricular system and initial signs of revascularization. Near the Sylvian fissure in the left temporal lobe, there is a small hyperdense area, a sign of petechial infarction. Shift to the right of the midline of 4 mm.

Case Discussion

The "loss of insular ribbon" sign denotes loss of grey-white interface in the insular cortex secondary to edema due to an ischemic insult. This is an early sign of acute MCA infarction and should be looked for carefully in the clinical setting of stroke.

Authors of this case are Dr. Dario Giambelluca and Dr. Giuseppe Salvaggio.

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