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Using CT or DWI, the authors categorized percentages of insular ribbon infarctions as less or more than 50% and correlated these with clinical outcomes. Only insular ribbon involvement greater than 50% and low NIHSS score at admission correlated with poor outcomes. They concluded that DWI–percentage insula ribbon infarct of >50% independently predicted poor clinical outcome and can help identify patients with stroke likely to have poor outcome despite small admission DWI lesion volumes.