Temporal lobe

2. Superior Temporal surface
•The superior surface
forms the lower limit of
the lateral fissure and
overlaps the insula.
• Within the lateral fissure,
three or four transverse
temporal gyri (Heschl
41,42)

3. Lateral surface
•Above – posterior ramus
of lateral fissure
•Below – inferiolateral
border of hemisphere
•Superior, middle and
inferior sulci and gyri

4. Inferior Temporal Surface

5. Histology
•Temporal lobe
–Six layered fairly equally
developed pyramidal and granular
layer
•Hippocampus
–Three layered allocortex

6. Connection
•Affrents
–Auditory cortex
•Medial Geniculate body
–Middle and inferior
temporal lobe
•Occipital lobes
•Efferent
–Opposite temporal lobe
•Anterior commissure
•Middle corpus callosum
–Anterior temporal and
orbitofrontal
•Uncinate fasciculus
–Broca’s area, motor cortex
•Arcuate fasciculus from
Posteriosuperior temporal
–Superior temporal cortex
–Limbic and paralimbic
cortex

7. Function
•Auditory - Visual
discrimination
•Memory
•Emotion
•Great integrator of
sensation, emotion and
behavior – Williams
•All sensory modalities
are integrated into
ultimate self
awareness

8. Visual dysfunction (21,37)
•Unilateral lesion
–Upper quadranopia (optic radiation)
–Visual Hallucination (middle and inf temporal gyri
– 21, 37)
–Altered visual perception
•Object appear too large – macropsia
•Too small – micropsia
•Too close or too far
•Unreal
•Bilateral lesion
–Psychic blindness, oral exploration

9. Hearing dysfunction (41,42)
•Unilateral lesion
–Threshold of brief auditory
stimuli elevated
–Spoken words less clear
–Distorted words are less
clear
–Difficulty in equalizing
sound presented to both ear
–Rapidly presented words
and number in both ear
difficult to perceiving
•Bilateral lesion
–Cortical deafness –
unaware of deafness
–Associated with
aphasia

10. Auditory Agnosia (21,22)
•Agnosia for sound
–All noises (bell, running of
water, rustling of paper)are
indistinguishable
–Associated with auditory
verbal agnosia and amusia
•Amusia
–Rt middle temporal
•Recognition of familial
melody and ability to name it
•Perception of pitch and timber
•Ability to produce and read
and write music
•Lowering of duration of note,
timber intention of sound
•Memory of melodies and
harmony
–Left middle temporal lobe
•Naming of musical score and
all the semantics (writing and
reading) aspect of music
•Auditory verbal agnosia (word
deafness)
•Failure of left temporal lobe
of deloading the acoustic
signals of speech and
converting them to
appropriate motor expression.

11. Auditory Illusion and
Hallucinations
•Auditory illusion
(sound)
–Either lobe lesion
•Loud or less loud
•Modification of timber
and tonality
•Paracusias - Strange or
disagreeable
•Repeated perseveration
•Auditory
hallucinations
–Either temporal lobe
•Elementary
hallucination and
dreamy state
–Left posterior lesion
•Complex polymodal
(musical and voices)
hallucination

12. Vestibular disturbance
•Superior and posterior part of temporal lobe
posterior to auditory cortex in the first and
second temporal convolution
•Activation
–Vertigo
•Destruction
–Change in the pattern of of optokinetic
stimulation

13. Time
•Disturbance of time perception
–Either temporal lobe
–Time stand still or pass great speed
–Confessional state, post seizure, Dementia

14. Non auditory syndromes
•Amnesic dysnomia –
defect in the retreval
of words (inferio
temporal lesion)
•Dominant lobotomy –
failure of learning
presented through
visually presented
material
•Non dominant
lobotomy – failure of
learning through
visually presented
material
•Either lobotomy 20% -
prefrontal syndrome

15. Emotional visceral and Sexual
function
•Uncinate fit – dreamy
state, gustatory and
olfactory hallucination
•Posterior temporal
activation – complex
memories of visual
and auditory images
with strong emotional
content
•Amygdaloid complex
stimulation
–olfactory sensation
–complex emotional
experience of past
–Increased BP and pulse
–Sexual abrasion
•Excessive arousal
•Over activity
•Reduced capacity

16. Temporal lobe functional
localization
•Transverse gyri of Heschle
41,42 – primary auditory cortex
•Area 22 (planum sphenoidale)
posterior to Hescle gyri on the
superior surface auditory area
•Function
–Verbal and Nonverbal
discrimination
•Vestibular receptive zone
posterior to auditory
•Middle and Inferior
convolution –
–visual discrimination
•Spatial orientation
•Estimation of depth and
distance
•Stereoscopic vision
•Hue perception
•Medial temporal lobe
–Visceral brain
–Hippocampal connection

17. Anterior Temporal Function
1.Auditory memory
disturbance
2.Learning and retention of
verbal material regardless
of whether material is
auditorily or visually
presented and regardless
of whether patient is
tested using recall or
recognition techniques.
3.Left anterior temporal lobe
does not affect memory
for places, faces,
melodies- etc.
1.Right anterior temporal
lobe damage impairs
recognition and recall of
visual and auditory
patterns that do not lend
themselves to verbal
coding.
2.Difficulty remembering
short auditory stimulation.
3.Deja vu.
4.Hallucinations (auditory
and/or visual).
5.Disinhibited social
behavior.

18. Anterior Temporal Tests
1.Paired associates
Seashore Rhythm
Test
2.Left vs. right
•Paired Associates
Verbal Story for
Immediate Recall
•Visual Memory
Seashore Rhythm Test
•Visual Memory
Seashore Rhythm
Test
1.Repeat short and long
sentences
2.Discern presence of
deja vu. Presence of
deja vu does not help
to lateralize lesion .
3.Discern presence and
nature of
hallucinations
4.Obtain recent history
concerning quality of
social judgment

19. Middle Temporal dysfunction
1.Acoustico-mnestic
disorders, can't retain
series of sounds, syllables
or words in memory.
–Comprehension of
individual words intact but
cannot retain more than 2
or 3 at once.
–In mild cases, patient can
retain essential elements
of series but cannot
remember correct order.
–Problem is due to
increased mutual inhibition
of auditory traces.
1.Do not have difficulty with
phonemic learning.
2.Difficulty reproducing
words or word series under
complicated conditions.
3.Impaired ability to name
series of objects.
4.Stimulation gives
hallucinations, memory
images, changes in state
of consciousness.

20. Middle Temporal Tests
1.Paired associates, long vs.
short series of words,
verbal story for immediate
recall.
1.Check for comprehension
of individual words in
above tests.
2.If items are remembered,
check for proper ordering.
3.Increase intervals between
presentation of individual
items in series and see if
performance improves.
1.Auditory
Discrimination Test
2.Introduce a distraction
interval before patient
repeats series.
3.Ask to name several
objects individually
and then all at once

21. Right Temporal dysfunction
1.Right temporal lesion effects tend
to be notable statistically but of
less clinical significance.
2.Visual analysis (nonverbal
primarily)
– Impairment of simple and
complex visual analysis, but some
negative findings.
– Impairment of short-term
nonverbal memory.
– Impaired perception of
tachistoscopically-presented
letters.
– Prosopoagnosia (especially with
anterior lesions).
– Impaired recognition of objects
seen from unusual angles
3.Auditory analysis
(nonverbal)
–Impairment of short-term
auditory memory.
–Perception of short sounds
impaired.
–Impaired recognition of familiar
sounds.
–Impaired tonal discriminations,
timbre discriminations, and
amplitude discriminations.
–Amusia.
–Impairment of contralateral ear
input in dichotic listening.

22. Right Temporal dysfunction
4.Constructional tasks
–Visual construction impairment
proportional to tissue loss.
–Impairment in maze learning
(visual and proprioceptive
feedback).
–Enlarged left-hand margin in
dictation.
5.Psychiatric personality
phenomena with right temporal
epilepsy
–Personality changes.
–Psychiatric symptoms.
–Deja vue.
–Metamorphopasias.
6.Psychometric findings
–Temporary decline in
Performance IQ following
lobectomy.
–Impairment on WAIS
Picture Arrangement.
–Impairment on Binet
Memory for Designs
–Possible impairment of
WAIS Block Design?.
7.Persistence in maintaining
a hypothesis even after
being informed it was not
correct.

23. Right Temporal Tests
•Impairment on WAIS
Picture Arrangement.
•Impairment on
Seashore Test of
Musical Talent
(especially Tonal
memory, Timbre,
Loudness, and Time).
•Dichotic thresholds.
•Impairment of short-
term memory for other
nonverbal acoustic
tasks.
•Lezak and others
–Have the patient identify a
tune the examiner hums. If
unsuccessful, try several
other familiar melodies to
check for amusia.
–Test pitch discrimination with
pitch pipe.
–Have patient try to
discriminate (or imitate)
different rhythmic tapping
patterns. A memory
component may be added.
–Test recognition of familiar
sounds.
–The examiner may pair verbal
and nonverbal material to
clarify the interpretation of a
patient's failures.

24. Right Temporal Tests
•Impairment of short-term
memory for other
nonverbal acoustic tasks.
•Visual recognition deficits
(prosopoagnosia included)
–Impairment of recognition
of photographs of faces.
–Impairment on Closure
Faces Test (Mooney).
–Impairment on McGill
Picture Anomalies Test.
–Difficulty in identifying
pictures of objects viewed
from unusual angles.
•Impairment of other nonverbal
visual tests of short-term
memory and visual
discrimination or Binet
Memory for Designs Test.
•Corsi's block-tapping test.
•Impairment on stylus maze
tasks (visual or proprioceptive
feedback).
•Impairment in enumeration of
tachistiscopically-presented
dots.
•Enlarged left margins in
dictation.
•In epileptics a history of strong
deja vue experiences or
metamorphopsia

25. Left temporal dysfunction
•Auditory deficits (right
ear)
–Intracranial localization
of sound is impaired.
–Increased threshold for
perception of short
bursts of sound.
–Increased threshold for
some frequencies.
–Failure to perceive brief
simultaneous auditory
stimulation.
•Visual deficit (both
eyes)
–Upper right
quadrantanopsia.
•Other complex
sensory deficits
–Right hand tactile
performance difficulty.
–Right hand finger
agnosia.

26. Left temporal dysfunction
•Language deficits
–Decoding of speech
sounds (phonemes) is
impaired.
–Problems with verbal
repetition.
–Problems with auditory
comprehension of speech.
–Receptive aphasia
(deficits in all language
qualities).
–Impairment of dichotic
listening to verbal material.
–Intellectual impairment on
verbally mediated
intellectual processes.
•Memory impaired for
verbal material.
•Impairment on
measures of higher
cortical functions
(Trails A and Trails B).
•Emotional
disturbances
–Perceptual distortions,
alterations of mood,
obsessional thinking,
psychosis, temper
outbursts, hypo and
hypersexuality

27. Left temporal tests
•Auditory tasks
–Binaural localization of
clicks.
–Simultaneous auditory
messages.
–Short duration tone
bursts-threshold
testing.
–Frequency threshold
testing.
–Dichotic listening.
•Visual testing
–Test visual
perimetry.
•Complex sensory
tests
–Tactual
performance test.
–Finger agnosia test.

28. Left temporal tests
• Linguistic abilities tests
– Speech sound perception test.
– K-V auditory discrimination test.
– Token test (for comprehension).
– Aphasia exams
– Wepman-Reitan Aphasia
Screening Test.
– Porch Index of Communicative
Ability.
– Boston Diagnostic Aphasia
Examination.
– Dichotic listening.
• Measures of Intelligence
– Wechsler Adult Intelligence Scale;
sensitive subtests include
similarities, arithmetic, and digit
symbol.
• Assessment of verbal memory
– Hebb's recurring digits (digit span
with every third list is repeated).
– Consonant trigrams (recall of a
spoken set of three consonants
following distraction).
– Discrimination of recency (subject
required to indicate which of two
verbal stimuli they have seen
most recently).
– Recall of Logical Memory from
Wechsler Memory Scale after a 1
hour delay.
– 7 Assessment of higher cortical
functions
– Trails A and Trails C.
• Emotional disturbances
– MMPI.

29. Wernicke’s Area
•Motor weakness is typically
minimal or absent.
•There may be a partial
hemianopsia
•Word output is normal or
increased, with many
paraphasic errors, and
speech is often
incomprehensible (jargon
aphasia).
•Paraphasic errors include
elogisms ("Slep", "gort"),
phonetic distortions ("good"
for "wood") and semantic
mistakes (Chevy for Ford).
•Auditory (speech) and visual
(reading) comprehension are
severely disturbed.
•The patient cannot follow 2
or 3 part commands
•One part commands can
often be followed
•Repetition is impossible.
•The severe comprehension
disorder often makes testing
of other cognitive functions
difficult.
A region of the brain located in the posterior, superior
temporal gyrus, adjacent to the cortical region for hearing

30. Aphasia Tests
1.Porch Index of
Communicative Ability (PICA)
2.Token Test
3.Token Test (3E-item version)
–Appears to be a useful and
convenient device to
diagnose aphasia impairment
of language comprehension.
•Boston Diagnostic Aphasia
Battery
•Western Aphasia Battery
•Minnesota Test for Differential
Diagnosis of Aphasia
1.Halstead-Wepman Aphasia
Screening Test
2.Head's Serial Tests
3.Language Modalities Test
4.Illinois Test of Psycholinguistic
Abilities
5.Michigan Picture Language
Inventory
6.Functional Communication
Profile
7.Examining for Aphasia
8.Sklar Aphasia Scale
9.Neurosensory Center
Comprehensive Examination
for Aphasia

31. Either Temporal dysfunction
•Upper quadranopia
•Hallucination
–Auditory,
–visual,
–olfactory and
–gustatory
•Altered visual perception
–Object appear too large –
macropsia
–Too small – micropsia
–Too close or too far
–Unreal
•Auditory
–Threshold of brief auditory
stimuli elevated
–Spoken words less clear
–Distorted words are less clear
–Difficulty in equalizing sound
presented to both ear
–Rapidly presented words and
number in both ear difficult to
perceiving
•Dreamy state with uncinate seizure
•Emotional and behavioral changes
•Delirium

32. Bitemporal dysfunction
•Kluver Bucy syndrome
(Animal)
–Apathy and placidity – lack
of usual emotional reaction
to stimuli
–Increased sexual activity
–React to every visual
stimuli without recognizing
it (Psychic blindness) oral
exploration
•Sham rage
•Korsakoff amnesic defect
•Human bitemporal lesion
–Kluver bucy like + aphasia,
amnesia and bulimia
•Bilateral inferior and
medial temporal lesion
–Sham rage like
–React to every stimuli with
extreme belligerence,
screaming, cursing , biting
and spiting
•Bilateral post cortical
lesion
– Cortical deafness –
unaware of deafness