Neuroimaging Tip - Loss of the Insular Ribbon Sign

• Loss of the insular ribbon sign refers to loss of the gray-white differentiation of the insular cortex.
• This is an early sign of middle cerebral artery (MCA) stroke.
• The insular cortex has less collateral blood supply from the anterior cerebral artery (ACA) and posterior cerebral artery (PCA) than other portions of the MCA territory; thus making it more susceptible to ischemia.

 

 

References

• Truwit CL, Barkovich AJ, Gean-Marton A, Hibri N, Norman D. Loss of the insular ribbon: another early CT sign of acute middle cerebral artery infarction. Radiology. 1990;176(3):801-6.
• Weekarkkody Y. “Loss of the insular ribbon sign” Radiopaedia.org. Accessed August 12, 2015. http://radiopaedia.org/articles/loss-of-the-insular-ribbon-sign