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Rationale and Objectives This study evaluated the altered regional cerebral blood flow (rCBF) in resting state in patients with acute posttraumatic stress disorder (PTSD) 3 months after trauma. Materials and Methods The rCBF was measured in 30 patients with acute PTSD and 36 healthy controls. Results Survivors with acute PTSD showed decreased rCBF, the Clinician-Administered PTSD Scale score correlated negatively with the rCBF, and rCBF at resting state decreased in acute PTSD. Conclusions PTSD symptom severity was associated with diminished cerebral blood flow in the right insular cortex and right orbital medial frontal gyrus. The rCBF may predict PTSD symptom severity.

A 43-year-old man presented to the Prince of Wales Hospital, Sydney, New South Wales, Australia, after experiencing his first tonic-clonic seizure. For the previous 2 years he had undergone gastroenterological investigation of episodes of gagging associated with hypersalivation and lachrymation, occurring three or four times per week. EEG showed epileptiform discharges in the right anterior temporal region; brain MRI revealed a lesion in the right insular cortex. Video-EEG telemetry demonstrated that the episodes of gagging were focal seizures. Antiepileptic drug therapy resulted in no further episodes occurring over the next 10 months.

A significant reduction in perfused microvasculature in right caudate nucleus and right insular cortex was demonstrated in 22 monkeys at 0.5, 4, 12, 24, and 48 hours and 2 weeks following transorbital occlusion of the right middle cerebral artery (RMCA). The microvasculature was visualized by an india ink perfusion method and subjected to morphometric analysis with a Leitz ASBA image analysis system. The reduction in number, length, and changes in diameter of the microvessels visualized with india ink are discussed.

The perception of dyspnea and pain show many similarities. Initial imaging studies suggested an important role of the insular cortex for the perception of both sensations. However, little is known about the cortical processing of dyspnea.This study investigated the influence of lesions of the insular cortex on the perception of dyspnea and pain.Dyspnea was induced by resistive loaded breathing in four patients with right-hemispheric insular cortex lesions, as assessed with computer tomography or magnetic resonance imaging, and four matched healthy control subjects. Pain was induced by a cold-pressor test. Perceived intensity and unpleasantness of both sensations were rated on visual analog scales.In contrast to healthy control subjects, patients with lesions demonstrated reduced perceptual sensitivity for dyspnea, in particular for the unpleasantness of dyspnea (P0.05). This was paralleled by reduced sensitivity for pain in patients with lesions, as reflected by smaller ratings of intensity and unpleasantness, higher sensory pain-thresholds, and, in particular, higher affect-related pain tolerance times (P0.05).The results suggest that lesions of the right insular cortex are associated with reduced sensitivity for the perception of dyspnea and pain, in particular for their perceived unpleasantness. This underlines the importance of the insular cortex for the perception of both sensations.