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The No Smoking Sign—Insular Infarction
Author(s) -
Hefzy Hebah,
Silver Rachel Wulf,
Silver Brian
Publication year - 2011
Publication title -
journal of neuroimaging
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.822
H-Index - 64
eISSN - 1552-6569
pISSN - 1051-2284
DOI - 10.1111/j.1552-6569.2010.00486.x
Subject(s) - medicine , smoking cessation , stroke (engine) , infarction , nicotine , insular cortex , insula , neurological examination , pediatrics , myocardial infarction , psychiatry , pathology , mechanical engineering , archaeology , engineering , history
BACKGROUND Cigarette smoking is the most common preventable cause of morbidity and mortality in developed countries. Smokers with brain damage involving the insula are 136 times more likely to stop smoking immediately after the injury than smokers with brain injuries elsewhere.METHODS Case ReportRESULTS A 58‐year‐old woman with a history of hypertension, coronary artery disease, and 40 pack‐year history (1 pack per day for 40 years) of smoking presented with sudden confusion and word‐finding difficulty. Initial neurological examination showed disorientation to time, difficulty following commands, and perseveration. No focal motor, sensory, or visual deficit was present. Noncontrast head CT showed a new insular ischemic stroke. Five months after discharge from the hospital, the patient reported that she had not resumed smoking cigarettes, had not used any smoking cessation aids, and had not intended to stop smoking. Her daughter reported that “it was as if she forgot that she used to smoke.”CONCLUSION Unintentional abrupt smoking cessation serves as a unique lesion localizer. Insular hypocretin transmission plays a permissive role in the motivational properties of nicotine in animals. Whether the mechanism of smoking cessation relates to hypocretin secretion has yet to be proven in humans.