Neuropsychiatric effects of insular stroke

The neuropsychiatric effects of insular damage in humans have not previousl y been examined. We therefore examined the neuropsychiatric impairment in s even patients with left insular stroke, six patients with right insular str oke, six patients with left hemisphere noninsular stroke, and six patients with right hemisphere noninsular stroke. Between 4 and 8 weeks after acute stroke, patients were administered a neuropsychiatric battery. Patients wit h right insular lesions had a greater frequency of subjective anergia and u nderactivity (Fisher's exact p < .002) as well as tiredness (Fisher's exact p < .002) compared with patients with non-insular lesions or left insular lesions. Subjective feelings of impaired energy or drive after right insula r damage may result from disconnection between the insula and the frontal l obe or the anterior cingulate cortex, structures that have been associated with willed action and motor behavior.