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.
