Clinical Anatomy

and Functions of
the Insula

Moderator
Prof. Manjari Tripathi
Presented by: Dr. Divyani Garg
 Search strategy
• Keywords –insula, insular cortex, insular
anatomy, vascular supply, insular connections,
insular functions,cytoarchitecture, functional
anatomy, insular epilepsy
• Database – Pubmed, Google scholar, Journals
(Neurology, Brain, Lancet, JAMA etc)
• Textbooks – Bradley etc
 Overview
• Insula Anatomy
– Gross anatomy
– Cytoarchitecture
– Vascular supply
– Connections
• Functions
• Clinical Significance
– Seizure
– Dementia
– Autonomic system
INSULA

ANATOMY
 Insula-Anatomy
• Johann Christian Reil (1809)

• “terra incognita”

• Completely covered by its neighboring cortical

structures—the frontal, the parietal and the temporal
operculum

• 2% of cortical surface area

Brain Struct Funct (2011) 216:137–149

Insula-Anatomy
Insula-Anatomy
Insula-Anatomy
 Insula-Gross Anatomy
• Central sulcus -anterior and
a posterior part 
• Anterior part-AIC
– the anterior, middle and
posterior short gyrus
– additional accessory
gyrus
• Posterior part-PIC
– two long gyri –anterior
and posterior separated
by postcentral sulcus

Adv. Tech. Stand, Neurosurg, 2004;29:265-88; Surgical anatomy of the insula.;Guenot

M, Isnard . J,
 INSULA

VASCULAR SUPPLY
 Insula-Vascular supply
• Average of 96 ( 77–112)
• Middle cerebral artery
(MCA), predominantly the
M2segment
• 1-6 arteries from
M1 segment
• 1-2 from M3 segment
• Drains via deep middle
cerebral vein

Arteries of the insula; Uğur Türe, M. Gazi Yaşargil, Ossama Al-Mefty, Dianne C. H.
Yaşargil,Journal of Neurosurgery, April 2000 / Vol. 92 / No. 4 : Pages 676-687
 INSULA

CYTOARCHITECTURE
 Insula-Cytoarchitecture
• Based on the degree of
granularity of neurons

• Tripartition:

• Anterior agranular cortex

(Ia)
• Intermediate dysgranular
(Id)
• Posterior granular cortex
(Ig)

Mesulam and Mufson; Insula of the Old World monkey. I. Architectonics in the
insulo-orbito-temporal component of the paralimbic brain, J. Comp. Neurol., 212
(1982) 1-22
• Anterior agranular part:
– Site of processing emotional, motivational, cognitive
and sensory stimuli, gustation
• Intermediate dysgranular part of insula:
– Widely connected
– Involved in motor, somatosensory and pain processing
• Posterior granular part
– constantly receiving information about autonomic
functions
– Input carried to anterior part
– integrates interoceptive input with cognitive information

Mesulam and Mufson; Insula of the Old World monkey. I. Architectonics in the
insulo-orbito-temporal component of the paralimbic brain, J. Comp. Neurol., 212
 INSULA

CONNECTIONS
 Insular Circuitry
• Cerebral cortex
• Basal ganglia
• Amygdaloid body
• Other limbic areas
• Dorsal thalamus

• Circuitry and functional aspects of the insular lobe in primates including

humans ; Augustine; Brain Research Reviews; 22 (1996) 229-244
FREDERICK G. FLYNN (1999): Anatomy of the insula functional and clinical correlates, Aphasiology, 13:1,

55-78
Anatomy of the insula functional and clinical correlates, Aphasiology, 13:1, 55-78
Anatomy of the insula functional and clinical correlates, Aphasiology, 13:1, 55-78; 1999
Pathways in insular epileptogenic network

• 1. temporo-perisylvian-insular networks :
regions bordering sylvian fissure, i.e., three
operculum with insula
• 2. temporo-limbic-insular networks: mesial
temporal structures and/or the temporal pole
• 3. mesial and orbito frontal-insular networks

Journ. Neur. Neurosc. Vol 6 No. 2:9, 2015, T. Sun et al

 Subcortical Connections

Anatomy of the insula functional and clinical correlates, Aphasiology, 13:1, 55-78; 1999
 Intra-Insular Connections
• Anterior insula receives afferents primarily
from adjacent agranular and anterior
dysgranular areas
• Mid-insula receives afferents and sends
efferents in both directions
• Posterior insula receives afferents; sends few
efferents

Anatomy of the insula functional and clinical correlates, Aphasiology, 13:1, 55-78; 1999
 Functional Organisation
• Posterior to anterior functional organization
• Posterior locations evoke somatosensory
symptoms, with sensations of warmth and/or
pain localized more dorsally
• Central locations evoked viscerosensory
symptoms
• Gustatory sensations localized more anteriorly

J Neuropsychiatry Clin Neurosci 26:4, Fall 2014

J Neuropsychiatry Clin Neurosci 26:4, Fall 2014
INSULA

FUNCTIONS
 Insular Functions
1. The insula as a visceral sensory area
>The insula is part of the primary cortical gustatory area
>The insula receives potentials evoked by esophageal
stimulation
>The insula has a role in rare cases of partial seizures
2. The insula as a somatosensory area
>The insula has a role in tactile recognition and recall
>The insula has a role in asymbolia for pain
>The insula has a role in the pseudothalamic pain syndrome

Anatomy of the insula functional and clinical correlates, Aphasiology, 13:1, 55-78; 1999
3. The insula as a multifaceted sensory area
> The insula and feeding
>The insula and neglect

4. The insula as limbic integration cortex

>The insula and simple phobias

5. The insula as a visceral motor (autonomic) area

>The insula has a role in vomiting
>The insula has a role in cardiovascular function
6. The insula as a motor association area
> The insula has a role in post-stroke recovery of motor
function
>The insula has a role in the ocular movements
7. The insula as a vestibular area
8. The insula as a language area
>The insula has a role in memory tasks related to language
>The insula has a role in auditory processing underlying
speech
9. The insula and dementia
10. Other insular functions
>The insula has a role in the verbal component of working
memory
>The insula has a role in selective visual attention
> Salience functions
 Insular Functions
1. Visceral Sensory functions
• 1. Part of primary cortical gustatory area
• 2. Receives potentials evoked by esophagus
• 3. Role in rare cases of partial seizures
• Primary Cortical Gustatory Area

• Changes in the regional cerebral blood flow

(rCBF) several seconds after electrical neural
activity (gustatory stimulation)
• Putative PGA in the middle dorsal insula and
the frontal operculum

Yaxley, S., Rolls, E.T. and Sienkiewicz, Z.J., Gustatory responses of single neurons
in the insula of the macaque monkey, J. Neurophys- iol., 63 (1990) 689-700.
• Penfield and Jasper (1954) : gustatory
sensation by electrical stimulation of the dorsal
middle-posterior insula and fronto-parietal
operculum

• Most frequently found at the transition area

between the posterior insula and parietal
operculum

Tomita, H. and Ikeda, M. (2002) Clinical use of electrogustometry: strength and

• Esophageal stimulation

• Cortical potentials evoked by balloon distention of

visceral region of human esophagus

• Dorsal and anterior part of the insula or in the

dorsal peri-insular cortex

[80] Weusten, B.L.A.M., Franssen, H., Wieneke, G.H. and Smout, A.J.P.M.,
Multichannel recording of cerebral potentials evoked by esophageal
balloon distension in humans, Digest. Dis. Sci., 39 (1994) 2074-2083.
2. Somatosensory functions:
• Tactile recognition and recall

• Tactile information relayed from somatosensory cortex

directed through the insula to
– the frontal cortex for short-term retention
– to structures of the medial temporal lobe for long-term
encoding

Neurology. 1999 Apr 22;52(7):1413-7.Neural pathways in tactile object recognition.

Deibert E
• Asymbolia for pain
• Recognize pain, lack appropriate motor and emotional
responses to pain
• Unresponsive to offensive visual and auditory threats

• Insula gateway (S1 and S2 and limbic structures eg.

Amygdala)
• Secondary to a sensory-limbic disconnection that
injures the insula and interrupts these
connections

J. Neuroscienc, 2009: Starr et al: March 4 :29(9): 2684-2694

• Pseudothalamic pain syndrome

• Burning or icelike contralateral pain

• Impairment of pinprick /temperature
appreciation
• White matter deep to caudal insula and
posterior parietal operculum
• Interruption of connections between these
areas and dorsal thalamus

• Operculo-insular/ parasylvian pain

Arch Neurol. 1992;Schmahman et al: 49:1032-1037

• 271 patients sent to the pain unit
• 21 had pure thalamic lesions
• 22 had cortico-subcortical lesions not
involving the thalamus/brainstem
• 5 patients were found to present dissociated
loss of thermoalgesic sensations
PATIENT LESIONS PAIN FEATURES

1 LEFT POSTERIOR INSULA- Right side of body/ face,

MEDIAL OPERCULUM burning, allodynia to cold
and brushing

2 RIGHT POSTERIOR INSULA- Left upper limb and

M.O trunk, burning, allodynia

3 RIGHT INSULA-M.O Left upper limb and

trunk, continuous
burning, allodynia to cold

4 RIGHT INSULA + FRONTAL Left hand and trunk,

OPERCULUM + continuous burning,
INFEROPARIETAL mechanical allodynia

5 RIGHT INSULA + MEDIAL Dyesthesiae upper limb

AND LAT. OPERCULUM contra- lateral to lesion
during acute phase only
3. Multifaceted sensory area
• Feeding

• IC regulate food choices based on post-

ingestive signals independent of gustatory role

Front. Syst. Neurosci. March 2012:Oliviera-Maia et al.

• Neglect
• Multimodality neglect

Neglect After Right Insular Cortex Infarction:F. Manes et. al: Stroke: 1999; 30: 946-948
4. Role in Limbic Integration
• Simple phobias

• PET brain with labelled CO2

• rCBF patterns in 7 patients during control and provoked
states
• Provocation of anxiety : significant increases in
rCBF
• Cortex of right anterior cingulate and right anterior temporal
lobes, left insular, left somatosensory, and left
posterior medial orbitofrontal cortices

A positron emission tomographic study of simple phobic symptom provocation, Arch.

Gen. Psychiatry, 52 (2005) 20-28. Rauch et al.
5. Visceral (motor) autonomic area
• Vomiting
• Audible rumbling or gurgling noises in GI
tract, vomiting, and the urge to defecate in
seizures involving the insula
• Intractable partial seizures: projectile
vomiting prominent

The role of the anterior insular cortex in ictal vomiting: a stereotactic

electroencephalography study: Epilepsy Behav. 2008 Oct;13(3):560-3: Isnard et al
 6. Cardiovascular function
• Bradycardia or depressor changes more common on
stimulation of the left insula

• Tachycardia or pressor changes more likely on the

right side

The Insular Cortex and Regulation of cardiac function, Comprn. Physiol, Volume 6, Issue
2, April 2016
7. Motor association area

• Post - stroke recovery of motor function

Ann Neurol. 1991 Jan;29(1):63-71. The functional anatomy of motor recovery after stroke in
humans: a study with positron emission tomography: Chollet et al.
Ann Neurol. 1992 May;31(5):463-72. Functional reorganization of the brain in recovery from
striatocapsular infarction in man: Weiller et al.
8. Language area

• Speech perception tasks preferentially activate the

left dorsal mid-insula
• Expressive language tasks activate left ventral mid-
insula
• Distinct regions of the mid-insula play different roles
in speech and language processing

The role of the insula in speech and language processing; Anna Oh et al; Brain and Language 135, August
2014, Pages 96–103
9. The Insula and Dementia

• Fronto-temporal Dementia
• Frontoinsular cortex [Area Frontoinsulare, or
“FI” of von Economo]
• Ventral agranular region: large, conspicuous,
Layer 5 bipolar neurons called von Economo
neurons (VENs)

Brain Struct Funct (2010) 214:465–475; Seeley et al; Anterior insula

degeneration in frontotemporal dementia
 von Economo Neurons
• A function of these
unique cells is to relay
the outputs of insular
and ACC to frontal and
temporal regions
• To aid rapid intuitive
assessments of
complex situations —
for instance, during
social cognition
Allman, J. M., Watson, K. K., Tetreault, N. A. & Hakeem, A. Y. Intuition
and autism: a possible role for Von Economo neurons. Trends Cogn.
• Ventral agranular frontoinsula
– diverse viscero–autonomic–nociceptive challenges
– co-activates with the amygdala and pregenual ACC
during social–emotional situations
• Dominant dorsal anterior insula activates in
response to
– speech and language fluency tasks
– lesions in the nearby dorsal mid-insula produce
speech apraxia
• bvFTD involves both ventral and dorsal
anterior insula at early clinical presentation

• Semantic dementia begins as a left or right

temporal pole disease
– spreads preferentially to ventral anterior insula

• PNFA, the dominant dorsal anterior insula

receives brunt of injury
• Right AIC most consistently affected structure
in FTD
• Reduced intrinsic functional connectivity of
the salience network
– poor judgement, loss of initiative, deficiencies in
self-control and a profound loss of interpersonal
warmth, tact and empathy

Schroeter, M. L., Raczka, K., Neumann, J. & von Cramon, D. Y. Neural networks in
frontotemporal dementia — a meta-analysis. Neurobiol. Aging 29, 418–426 (2008
• Alzheimer’s dementia

• Insular cortex associated with neuropsychiatric symptoms

(NPS) and distinct changes in cardiovascular and autonomic
control and mortality

• Regional atrophy of the insular cortex associated with

neuropsychiatric symptoms in Alzheimer's Disease patients

• Neuropsychiatry Neuropsychol Behav Neurol. 1997 Apr;10(2):81-9.Atrophy of the

hippocampus, parietal cortex, and insula in Alzheimer's disease: a volumetric magnetic
resonance imaging study. Foundas AL
10. Other Insular functions
>The insula has a role in the verbal component
of working memory
>The insula has a role in selective visual
attention
> Salience functions
• Salience functions
• ‘‘Saliency network’’ implemented by the
insula and the anterior cingulate cortex
• Dysregulation of salience-processing systems
– Autism
– Schizophrenia
– FTD

Nature Reviews Neuroscience | AOP, 19 November 2014;Uddin

Insular Epilepsy
 Insular Epilepsy
• Concept of “insular cortex epilepsy” first
proposed by Guillaume and Mazars
• Subsequently; Penfield and Jasper: semiology
similar to that of temporal lobe seizures
• Implicated in the 30% failure rate after
temporal lobe resections for medial temporal
lobe epilepsy
Epilepsia
Volume 45, Issue 9, pages 1079–1090, September 2004
• 50 consecutive patients
• Stereo-electroencephalographic (SEEG) ictal
recordings and direct electric cortical
stimulation
• All patients had video-EEG–recorded complex
partial seizures associated with scalp EEG
discharges picked up at temporal electrodes
sites
• Stimulations performed in 144 insular sites in
50 patients
• Clinical responses evoked in 125 of sites
• Total 139 evoked clinical responses collected

• 31 identified by patients as identical to ictal

symptoms of their spontaneous seizures
• 108 reported as unknown and not similar to
the usual ictal symptoms
• Common characteristics of seizures with insular
epilepsy:
• 1. Consciousness
• 2. Sensory premonitory symptom before the
paroxysm: always manifested as sensation of
electric current or burning heat (perioral or larger
area)
• 3. Ever-present abnormal sensation of retrosternal
pain, abdominal elongation, distension, nausea,
vomiting, dyspnea, mogiphonia or anarthria
• 4. Pharyngeal symptoms of movement and
sensation of paroxysm, accompanied with
contralateral hands of the discharge side, and
extending to the cervix, to grab and scratch

• 5. Movement symptoms in the ipsilateral or

contralateral discharge side, such as facial or
upper limb spasm, rotating head or eyes, and
systemic dystonia
 Responses
• Somatosensory responses
• Viscerosensitive responses
• Auditory responses
• Dysarthria
• Other types of responses
 Somatosensory responses
• Posterior ¾ of the explored area
• 43% of the evoked responses (n = 58)

• Neutral or unpleasant nonpainful paresthesiae,

pins and needles, slight electric curent; warmth or
violent and painful electric discharge

• Localized 49 times contralateral to stimulation

• 6 times ipsilateral
• 3 bilaterally distributed
 Viscerosensitive responses
• Anterior ¾
• 22% of the evoked responses (n = 34)

• 16: pharyngolaryngeal region (unpleasant

sensation of constriction, breathing discomfort to
strangulation)
• 16 : similar to temporomesial seizures (abdominal
heaviness, thoracic constriction, unpleasant
ascending epigastric and retrosternal sensation,
sudden flush, nausea)
• 2 : abdominal pain
 Auditory responses

• 10% of the evoked responses (n = 14)

• Only 1: complex auditory illlusion, described
as a muffling of sounds as if “there were no
echo; ”
• All others: Buzzing or whistling, either diffuse
or coming from the space opposite the
stimulated side
 Dysarthria
• 6% of the evoked responses (n = 9)
• During a reading or a loud voice counting task
• Sensation that their jaws were blocked; no
paraphasia
• 4: similar symptom during their seizures
• Response was obtained 5 times by stimulating the
dominant hemisphere for language
• 4 times during stimulation of the nondominant
hemisphere
 Other types of responses

• Sensation of unreality (4% of the evoked

responses; n = 6)
• Whole-body sensations (4% of the evoked
responses; n = 6)
– Sudden sensation of displacement in space, eg.
brisk forward projection, a vertical or horizontal
rotation of body, sensation of levitation
• Olfactogustatory responses (2% of the evoked
responses; n = 3)

• Vegetative responses (2% of the evoked

responses; n = 3) (facial rubefaction,sweating)
• 138 seizures in 50 patients
• In 5, seizures originated from insular cortex
• In 43 patients, propagated to the insula after
temporal onset
• In 2 patients, insular cortex remained
unaffected by ictal discharges
• In 6 patients, specific ictal symptoms
correlated with discharge affecting selectively
insular cortex
• In one (case 6), the seizures confined to
mesiotemporal and insular areas, with a
sustained and widespread discharge in the
insular lobe and no spreading to any other
cortical area
Case 1
 Semiology
• Seizures began by paresthesiae in the chest
ascending toward the throat, the mouth and the left
shoulder to body

• Feeling of mirth and clairvoyance

• Ended with a dysarthria progressing to a complete

muteness

• Occurrence of dystonic posture of left upper limb,

followed by clonic jerks in the left arm and face
 SEEG
•Ictal discharges at seizure onset consisted of a low-
voltage fast recruiting activity, ending in a discharge
of high-frequency spikes in the posterosuperior
quadrant of the insula

•During the first 15 s of seizures, these discharges

were undetectable at any other recording site outside
the insula

•Occasionally the discharge would secondarily

propagate into the mesial temporal structures
Case 2
 SEMIOLOGY

• Seizures began with an unpleasant sensation in the throat

followed by a sensation of tingling and warmth in the lip
commissure, cheek, or whole face on the right side

• The seizure could be confined to these subjective

manifestations or continue with a loss of contact,
oroalimentary movements, and involuntary walking

• The patient also had unilateral convulsive seizures beginning

as a left arm and left hemi- facial tonic contraction
 SEEG
•Discharges of recruiting rhythmic spikes originated
in the posterior part of the left insula
•Spread in 2 min to the rostral and then to the inferior,
insular cortex before invading the outer aspect of the
frontal and the temporal operculum
•The left unilateral convulsive seizures occurred
secondary to a tonic discharge developed within the
right precentral gyrus
CASE 3
 SEMIOLOGY
• Seizures consistently began by paresthesiae in the gums with a
sensation of tension in the sublingual salivary glands
• Nonpainful electrical paresthesiae in the lower lip spreading
after several seconds to the left forearm and palm of the hand
• Hypersalivation followed by clonic jerks in left arm and in left
side of face without secondary convulsive generalization

• During seizure development, patient’s spontaneous speech

became more dysarthric, to end into complete mutism which
lasted for several seconds after the end of the ictal discharge
 SEEG
•The seizure onset : a rhythmic recruiting discharge
beginning in the posterior part of the right insular
cortex

•Invading progressively the whole insular lobe,

mesiotemporal structures (hippocampus and
parahippocampal gyrus), and then both supra- and
infrasylvian opercular regions
CASE 4
 SEMIOLOGY
• Seizures began with laryngeal discomfort described
as “an unpleasant sensation of constriction”, which
was occasionally associated with the perception of a
sound described as “a diffuse buzzing”

• At the next stage of the seizure, the patient looked

pale, very anxious, swallowed compulsively, and
reported a tingling sensation in her chin and lips
spreading occasionally to the left upper limbs and
then hypersalivation consistently occurred
 SEEG
•Seizure onset characterized by a low-voltage fast
rhythmic activity originating in the anteroinferior
quadrant of the right insula, which propagated to the
postero- superior quadrant within 200 ms and last to
the anterosuperior quadrant, where the discharge
consisted of rhythmic spikes

•The second seizure type was associated with a

recruiting discharge of spikes in the hippocampus,
followed by a low-voltage fast rhythmic activity in
the posteroinferior and then in the antero- and
posterosuperior insular quadrant
CASE 5
 SEMIOLOGY

• Seizure onsets were marked by a light tingling sensation of

increasing intensity up to a sensation of intense, but
nonpainful, warmth localized either in the whole left half of
the body or in only some parts of it (cheek, hand, or foot)
• Patient became progressively dysarthric until complete
muteness, but still was able to perform simple tasks on verbal
command.

• The next stage : loss of contact, with face rubefaction and

automatic licking movements
 SEEG
•At the onset of seizures, a low-voltage fast rhythmic
activity was seen in the posteroinferior quadrant of
the right insula, propagating toward the superior
temporal gyrus, and then to the suprasylvian
opercular cortex, and last, to the precentral gyrus
 Case 6
• The first symptom was a painful abdominal sensation,
followed, a few seconds later, by automatic left fingers
opening and clenching movements

• At the same time, the patient reported a squeezing sensation

deep in her throat, was restless, and looked anxious

• Automatic movements of chewing and licking while she

rubbed her face compulsively and re-ported a pins-and-needles
sensation first in her left cheek for 25 s and then spreading to
the left arm, and occasionally, to the left lower limb

• Tonic or clonic motor symptoms were never observed

 SEEG
•Seizure onsets were manifested by a fast discharge of
spikes in the hippocampus and the amygdala; 200 ms
later, the discharges invaded the insular cortex
•50 s later, a low-voltage fast activity developed in the
insular lobe, and 20 s later, it popped out of the
hippocampoinsular regions and spread to the external
temporal areas
 Other Insular Seizures
• Insular seizures causing sleep-related
breathlessness
– Lancet: Volume 382, No. 9906, p1756, 23
November 2013
• A gut feeling about insular seizures
– BMJ Case Rep. 2011; 2011: bcr1220103647
 CLINICAL EFFECTS OF INSULAR
DAMAGE
• 3 major types of lesions investigated in the
human insular cortex:
– vascular
– tumoral
– traumatic brain injury (TBI)

Brain Struct Funct (2010) 214:397–410: Ibanez et al

• INSULAR STROKE
• Autonomic functions
• Stroke-induced insular lesions associated with
– ST abnormalities,
– higher rates of sinus tachycardia
– ectopic beats
• Stimulation of left insular cortex associated with
bradycardia and depressor effects
• Right insular cortex stimulation triggers
tachycardia and pressor responses
Fink JN, Selim MH, Kumar S, Voetsch B, Fong WC, Caplan LR (2005) Insular cortex
infarction in acute middle cerebral artery territory stroke. Arch Neurol 62:1081–1085
• Taste and gustatory perception
• Insular activation, as well as activation of
opercular cortex, in response to tastes and
smells
• Odor-induced taste impairments in patients
with insular lesions
• Ipsilateral tongue taste intensity affected by
insular lesions

Pritchard TC, Macaluso E, Eslinger PJ (1999) Taste perception in patients with insular
cortex lesions. Behav Neurosci 113:663–671
• Auditory processing
• Deficits in central auditory function, and
especially temporal resolution and sequencing

Bamiou DE, Musiek FE, Stow I, Stevens J, Cipolotti L, Brown MM,Luxon LM (2006)
Auditory temporal processing deficits in patients with insular stroke. Neurology
67:614–619
• Somatosensory systems and pain

• SS provides information about

– body parts
– localization of touch, stroking and pain
– features of external stimulus
– implicated in all physiological motor actions
• Bodily awareness affected in patients with
lesions of the insula
• May experience somatic hallucinations,
somatoparaphrenia and sensory self-
monitoring deficits
• Vestibular-like syndrome-posterior insula
• Pain-anterior insula
• Neglect

Spinazzola L, Pia L, Folegatti A, Marchetti C, Berti A (2008) Modular structure of

awareness for sensorimotor disorders: evidence from anosognosia for hemiplegia
and anosognosia for
 • Emotion: disgust
• Mood and willed action
– subjective anergia, underactivity, and tiredness
• Language
• Conscious urge to take recreational drugs

nctions of the anterior insula in taste, autonomic, and related functions; Rolls ET: Brain Cogn. 2015 A
 Take home messages
• Insula not really an “island” due to extensive
connections

• Anterior and posterior insular have

functionally different roles

• Clinical significance in many conditions esp.

dementia and epilepsy
Thank you