TEMPORAL

LOBE
V M SALIMA HABEEB

1ST MSC CLINICAL PSYCHOLOGY

INTRODUCTION
• Cerebrum consists of two cerebral hemispheres, each cerebral
hemisphere consists of four lobes.
1. Frontal lobe
2. Parietal lobe
3. Occipital lobe
4. Temporal lobe.
 TEMPORAL LOBE

• The temporal lobes are important brain structures comprising

about 20% of the total volume of the cerebrum.
• This part of the brain is important for complex visual and
linguistic analyses and for the formation of new memories.
• The temporal lobes are readily recognizable brain structures
with a thumb-like appearance when viewed from the side, sit
behind the ears and are the second largest lobe.
• Their name simply reflects their location beneath the
temporal bone on the side of the head.
• The temporal bone, in turn, receives its name from the fact
that this is the place in which graying of hair starts, indicating
aging with the passage of time (L. tempus).
• It is located below the Sylvain Fissure and anterior to the
occipital cortex.
The temporal lobe has two sulci termed the superior
and inferior temporal sulci.
They divide the superolateral surface of this lobe into
superior, middle, and inferior temporal gyri, that
parallel the Sylvian fissure.

Lateral Aspect
• Two Sulci
– Superior temporal sulcus
– Inferior temporal sulcus
• Three Gyri
– Superior temporal gyrus
– Middle temporal gyrus
– Inferior temporal gyrus
SUPERIOR TEMPORAL GYRUS

• The superior temporal gyrus contains the auditory cortex, which is

responsible for processing sounds.
• The superior temporal gyrus also includes Wernicke's area, which (in
most people) is located in the le hemisphere. It is the major area
involved in the comprehension of language. The superior temporal gyrus
is involved in auditory processing, including language, but also has been
implicated as a critical structure in social cognition.
MIDDLE TEMPORAL GYRUS

• It is located between the superior temporal gyrus and inferior temporal

gyrus.
• Believed to play a part in auditory processing and language.
• It has been connected with processes as different as contemplating
distance, recognition of known faces, audio-visual emotional recognition,
and accessing word meaning while reading.
INFERIOR TEMPORAL GYRUS

• The region believed to play a part in high-level visual processing and

recognition memory.
• The fusiform gyrus or Fusiform Face Area (FFA) deals more with facial and
body recognition.
MEDIAL ASPECT
The mesial temporal lobe, also known as the medial temporal lobe, is,
as the name suggests, located on the medial aspect of the temporal
lobe.
The MTL is comprised of multiple structures including the
• Hippocampal formation,
• Amygdala,
• Entorhinal cortex, and
• Surrounding perirhinal and parahippocampal cortices
HIPPOCAMPUS
• Hippocampus is a scrolled structure located in the medial temporal lobe
• In cross section resembles a ‘sea horse’ (for which it is named).
• The hippocampus is connected to a number of adjacent cortical areas.
• The areas affiliated with the hippocampus include the perirhinal, entorhinal,
and parahippocampal cortex
• The hippocampal formation plays a role in memory consolidation.
• Damage to the hippocampus usually results in profound difficulties in
forming new memories (anterograde amnesia), and normally also affects
access to memories prior to the damage (retrograde amnesia) but does not
affect procedural memory.
Functions of Hippocampus
• Medial temporal lobe memory system – includes hippocampus and adjacent
cortex, Parahippocampal gyrus and perirhinal regions.
• This memory system is involved in the storage of new memories.
• Hippocampus is critical for long-term memory storage.
•It stores declarative memories, which are memories you can access,
remember and describe.
• Declarative memories include memories of events or memorized facts and
information.
• Hippocampus also helps with recognition memory, which is your ability to
recognize something — such as objects, sounds or faces — based on stored
memories.
Parahippocampal cortex
• The base of the hippocampus is continuous with entorhinal cortex,
which is part of the parahippocampal gyrus.
• Sensitive to familiarity with stimulus location or the geometry of
surrounding space.
• Patients with a lesion limited to parahippocampal cortex lose the ability
to acquire new topographic knowledge.
• The Parahippocampal Area responds selectively to visual stimuli that
convey information about the layout of local space.
AMYGDALA
• Amygdala = Greek for almond.
• Medial aspect of the temporal lobe.
• Amygdala perform primary roles in the formation and storage of memories
associated with emotional events.
• The amygdala is closely associated with the hippocampus and is
concerned with encoding and recalling emotionally charged memories.
• During retrieval of fearful memories, the theta rhythms of the amygdala
and the hippocampus become synchronized.
• In healthy subjects, events associated with strong emotions are
remembered better than events without an emotional charge, but in
patients with bilateral lesions of the amygdala, this difference is absent.
FUNCTIONAL ARES
• Temporal lobe of cerebral cortex includes three functional area:
A. Primary auditory area
B. Secondary auditory area or auditopsychic area
C. Area for equilibrium.
PRIMARY AUDITORY AREA
• Primary auditory area, also called audiosensory area, includes forms the
centre for hearing, is concerned with perception of auditory impulses,
analysis of pitch and determination of intensity and source of sound and the
perception of auditory sensation (sound).
• In humans the primary auditory cortex is located within Heschl’s gyrus (HG),
a relatively well-defined gyrus located transversely on the superior temporal
gyrus, deep within the Sylvian fissure.
WERNICKE’S AREA

•Wernicke area was first discovered in 1874 by a German neurologist, Carl

Wernicke, as the locus of damage of an aphasic syndrome characterized by
impairment in language comprehension and production.
• These patients are impaired in understanding words and sentences, and
their speech is riddled with errors, principally affecting the phonological
content of words.
• Wernicke area, a sensory speech centre situated in the posterior part of
superior temporal gyrus is responsible for the interpretation of auditory
sensation.
PHYSIOLOGY OF LANGUAGE
Language is one of the fundamental bases of human intelligence and a key part of
human culture.
• The primary brain areas concerned with language are arrayed along and near the
sylvian fissure (lateral cerebral sulcus) of the categorical hemisphere.
• A region at the posterior end of the superior temporal gyrus called the Wernicke
area is concerned with comprehension of auditory and visual information.
• It projects via the arcuate fasciculus (a bundle of axons that generally connects
the Broca’s area and the Wernicke’s area), to the Broca area in the frontal lobe
immediately in front of the inferior end of the motor cortex.
• Broca area processes the information received from Wernicke area into a detailed
and coordinated pattern for vocalization and then projects the pattern via a
speech articulation area in the insula to the motor cortex. This then initiates the
appropriate movements of the lips, tongue, and larynx to produce speech.
• It is involved in the comprehension of written and spoken language, in
contrast to Broca's area, which is primarily involved in the production of
language.
• An interesting observation is that although the auditory areas look very
much the same on the two sides of the brain, there is marked
hemispheric specialization.
• For example, Wernicke area is concerned with the processing of auditory
signals related to speech.
• During language processing, this area is much more active on the le side
than on the right side.
• Wernicke area on the right side is more concerned with melody, pitch,
and sound intensity.
SECONDARY AUDITORY AREA

• Secondary auditory area occupies the superior temporal gyrus.

• It is also called auditopsychic area or auditory association area.
• This area is concerned with interpretation of auditory sensation
along with Wernicke area.
• It is also concerned with storage of memories of spoken words.

AREA FOR EQUILIBRIUM

• Area for equilibrium is in the posterior part of superior temporal

gyrus.
• It is concerned with the maintenance of equilibrium of the body.
• Stimulation of this area causes dizziness, swaying, falling and
feeling of rotation.
FUNCTIONAL ASPECTS
A. Memory
• From a physiological point of view, memory is divided into explicit and implicit forms.
• Explicit or declarative memory is associated with consciousness, or at least awareness,
and is dependent on the hippocampus and other parts of the medial temporal lobes of
the brain for its retention.
• Mesial structures of the temporal lobe (amygdala, hippocampus, and rhinal cortex) all
have demonstrated roles in some aspects of the establishment of new memories.

B. Religiosity
• There is a clinical impression that some patients with right hemispheric temporal lobe
lesions undergo an increase in religiousness, sometimes to the extent that the term
‘‘hyperreligiosity’’ is applicable.
C. Emotion
• The amygdala, in particular, has been seen as contributing to normal and
abnormal emotional responses and experiences.
• Bilateral amygdaloid destruction causes a severe disturbance of normal
affective behavior (Kluver–Bucy syndrome); damage in humans is usually
unilateral and o en incomplete, but even unilateral amygdaloid damage
has led to changes in emotional experience.
• Recently, the amygdala has been implicated in the manifestations of
schizophrenia and bipolar disorder.
D. Visual Perception
• The areas associated with vision in the temporal lobe interpret the
meaning of visual stimuli and establish object recognition.
• The ventral part of the temporal cortices appears to be involved in high-
level visual processing of complex stimuli such as faces (fusiform gyrus)
and scenes (parahippocampal gyrus).
E. Face Recognition
• An important part of the visual input goes to the inferior temporal lobe, where
representations of objects, particularly faces, are stored.
• Storage and recognition of faces is more strongly represented in the right
inferior temporal lobe in right-handed individuals, though the le lobe is also
active.
• Damage to this area can cause prosopagnosia, the inability to recognize faces.
Patients with this abnormality can recognize forms and reproduce them.
• They can recognize people by their voices, and many of them show autonomic
responses when they see familiar as opposed to unfamiliar faces. However,
they cannot identify the familiar faces they see.
• The presence of an autonomic response to a familiar face in the absence
of recognition implicates the existence of a separate dorsal pathway for
processing information about faces that leads to recognition at only a
subconscious level.
• Persons with prosopagnosia are usually also unable to learn new faces,
at least when tested using conscious recognition.
• The disorder may be accompanied by difficulty recognizing (naming)
famous buildings, and such individuals may also have difficulty with
texture discriminations and color perception.
• In addition, attempts to name objects may result in the use of a general
category rather than the object’s unique name (e.g. ‘‘bird’’ rather than
the more specific ‘‘robin’’ or ‘‘peacock’’).
F. Language
• The temporal lobe holds the primary auditory cortex, which is important
for the processing of semantics in both language and vision in humans.
• Wernicke's area, which spans the region between temporal and parietal
lobes, plays a key role (in tandem with Broca's area in the frontal lobe) in
language comprehension, whether spoken language or signed language.
• FMRI imaging shows these portions of the brain are activated by signed
or spoken languages.These areas of the brain are active in children's
language acquisition whether accessed via hearing a spoken language
STRANGENESS & FAMILIARITY
• Stimulation of some parts of the temporal lobes causes a change in
interpretation of one’s surroundings.
• For example, when the stimulus is applied, the subject may feel strange
in a familiar place or may feel that what is happening now has happened
before.
• The occurrence of a sense of familiarity or a sense of strangeness in
appropriate situations may help the healthy individual adjust to the
environment.
• In strange surroundings, one is alert and on guard, whereas
in familiar surroundings, vigilance is relaxed.
• An inappropriate feeling of familiarity with new events or in
new surroundings is known as the déjà vu phenomenon
from the French words meaning “already seen.”
• This occurs occasionally in healthy persons, and it may also
occur as an aura (a sensation immediately preceding a
seizure) in patients with temporal lobe epilepsy.
DAMAGE OF TEMPORAL LOBE
8 principle symptoms of Temporal lobe damage
1. Disturbance of auditory sensation and perception
2. Disturbance of selective attention of auditory and visual input
3. Disorders of visual perception
4. Impaired organization and categorization of verbal material
5. Disturbance of language comprehension
6. Impaired long-term memory
7. Altered personality and affective behaviour
8. Altered sexual behaviour
 DISORDERS OF AUDITORY AND VISUAL
PERCEPTION

• Lesions of the le superior temporal gyrus produce problems of speech

perception with difficulty in discriminating speech and the temporal
order of sounds is impaired.
• Lesions of the right superior temporal gyrus can produce disorders of
perception of music with inability to discriminate melodies and produce
prosody
• The inferior temporal cortex is responsible for visual perception and
lesions produce inability to recognise faces.
 TEMPORAL LOBE EPILEPSY
• Temporal lobe epilepsy is the most common form of focal epilepsy. Seizures in
TLE start or involve in one or both temporal lobes in the brain.
• There are two types of TLE:
• Mesial temporal lobe epilepsy (MTLE) involves the medial or internal structures
of the temporal lobe. Seizures o en begin in a structure of the brain called the
hippocampus or surrounding area. MTLE accounts for almost 80% of all temporal
lobe seizures.
• Medial temporal lobe epilepsy usually begins around age 10 or 20, but it can start
at any age.
• Neocortical or lateral temporal lobe epilepsy involves the outer part of the
temporal lobe.
• This type of TLE is very rare and mostly due to a genetic cause or lesions such as a
tumor, birth defect, blood vessel abnormality or other abnormalities in the
temporal lobe.
Symptoms
• Symptoms depend on how the seizure begins.
• Patient may have an aura before a temporal lobe seizure. An aura is an
unusual sensation that feel before a seizure starts.
• Not everyone experiences an aura. They typically last from a few
seconds to two minutes.

Sensations during an aura include:

• Déjà vu (a feeling of familiarity), a memory or jamais vu (a feeling of
unfamiliarity).
• A sudden sense of fear, panic or anxiety; anger, sadness or joy.
• A rising sick feeling in your stomach (the feeling you get in your gut
riding a roller coaster).
• Altered sense of hearing, sight, smell, taste or touch
Symptoms of focal impaired awareness seizures include:

✰ “Staring into space” or a blank stare.

✰ Repetitive behaviors and movements (called automatisms) of
your hands (such as fidgeting, picking motions), eyes (excessive
blinking) and mouth (lip-smacking, chewing, swallowing).
✰ Confusion.
✰ Unusual speech; altered ability to respond and communicate
with others.
✰ Brief loss of ability to speak, read or comprehend speech
Geschwind syndrome

• Geschwind syndrome, also known as Gastaut-Geschwind, is a

group of behavioral phenomena evident in some people with
temporal lobe epilepsy.
• It is named for one of the first individuals to categorize the
symptoms, Norman Geschwind.
• Temporal lobe epilepsy causes chronic, mild, (i.e. between
seizures) changes in personality, which slowly intensify
over time.
• Geschwind syndrome includes five primary changes;
hypergraphia, hyperreligiosity, atypical (usually reduced)
sexuality, circumstantiality, and intensified mental life.
• Hypergraphia

Hypergraphia is the tendency for extensive and compulsive

writing or drawing, and has been observed in persons with
temporal lobe epilepsy who have experienced multiple
seizures.Those with hypergraphia display extreme attention to
detail in their writing. Some such patients keep diaries recording
meticulous details about their everyday lives.
• Hyperreligiosity

Some individuals may exhibit hyperreligiosity,

characterized by increased, usually intense, religious
feelings and philosophical interests,
• Atypical sexuality
People with Geschwind syndrome reported higher rates of
atypical or altered sexuality.
In approximately half of affected individuals hyposexuality is
reported. Less commonly, cases of hypersexuality have been
reported.

• Circumstantiality
Individuals who demonstrate circumstantiality (or viscosity) tend
to continue conversations for a long time and talk repetitively
KLÜVER–BUCY SYNDROME

Kluver-Bucy syndrome (KBS) is a neuropsychiatric disorder

due to lesions affecting bilateral temporal lobes, especially
the hippocampus and amygdala.

Clinical Features
★ Hyperorality (A tendency or compulsion to examine
objects by mouth)
★ Hypersexuality: Lack of social restraint in terms of sexuality,
with inappropriate sexual activity and attempted copulation
with inanimate objects
★ Bulimia, which is an eating disorder characterized by binge
eating, followed by purging, is also markedly seen and may
cause weight gain.
★ Hypermetamorphosis (Excessive attentiveness to visual
stimuli with a tendency to touch every such stimulus
regardless of its history or reward value)
★ Placidity, flat affect and reduced response to emotional
stimuli
★ Visual agnosia, psychic blindness) - Inability to recognize
familiar objects or faces presented visually
★ Amnesia
APHASIA

Definition: Any disturbance in the comprehension or expression of

language caused by a brain lesion.
• NON-FLUENT APHASIA, i.e. in lesion to Broca’s area results in slow
speech, difficulty in choosing words, or use of words that only
approximate the correct word. Comprehension is intact.
• FLUENT APHASIA i.e. in lesion to Wernicke's area may result in, in
which a person speaks normally, and sometimes excessively, but uses
jargon and invented words, that make little sense. The person also
fails to comprehend written and spoken words.
WERNICKE’S APHASIA
• Wernicke's aphasia is a language disorder that impacts
language comprehension and the production of meaningful
language due to damage to Wernicke's area of the brain.
• This condition is sometimes referred to as fluent aphasia,
sensory aphasia, or receptive aphasia.
• According to the National Aphasia Association, people with
Wernicke's aphasia can frequently produce speech that
sounds normal and grammatically correct.
• The actual content of this speech makes little sense.
• Non-existent and irrelevant words are o en included in these
individuals' sentences.
–Auditory comprehension is impaired, even unaware of his own speech, and
does not correct himself.
–Repetition impaired
–Reading impaired
–Naming impaired
–Writing impaired
–Patient o en is unaware of the defect

• Making up meaningless words

• Producing sentences that do not make sense
• Speaking in a way that sounds normal but lacks meaning
• Difficulty repeating words or phrases
• Being unaware of problems with speech
TEMPORAL LOBE TUMORS
• Perhaps produce the highest frequency of mental disturbances including
behavioral and personality changes.
• Associated with Seizure or may be completely unrelated to seizure
activity.
• Dominant temporal lobe tumors tend to produce the greater cognitive
disturbances both verbal and nonverbal functions than non-dominant.
Symptoms:-
• Slowing and asponteinity of speech and movement
• Pure amnesia, florid Korsakoff syndrome
• Affective disturbances are common
• Psychotic illness resembling schizophrenia
• Auditory hallucinations and atypical dream-like episodes,
depersonalization, blanking-out spells, and dazed feelings
• Visual hallucinations occurring within a hemianopic field of vision
• May present with depression
• Personality changes may occur
FRONTOTEMPORAL DEMENTIA (FTD)
• First described by Arnold Pick.
• Pick’s Disease: Characterised by progressive circumscribed atrophy of
frontal and temporal lobe cortices
• Frontotemporal dementia (FTD), a common cause of dementia, is a group
of disorders that occur when nerve cells in the frontal and temporal
lobes of the brain are lost. This causes the lobes to shrink. FTD can affect
behavior, personality, language, and movement.
• Symptoms typically start between the ages of 40 and 65, but FTD can
strike young adults and those who are older. FTD affects men and women
equally.
The most common types of FTD are:

✰ Frontal variant. This form of FTD affects behavior and personality.

✰ Primary progressive aphasia. Aphasia means difficulty
communicating. This form has two subtypes:

1. Progressive nonfluent aphasia, which affects the ability to speak.

2. Semantic dementia, which affects the ability to use and
understand language.
TRAUMATIC BLUNT INJURY OF
TEMPORAL LOBE

• Caused by a blunt force, a fall, concussive waves through the air (usually
an explosion) severe whiplash, toxins or infections.
• Symptoms :- Include all of the above temporal lobe disorder symptoms,
plus difficulty recognizing faces (prosopagnosia) short-term memory loss
and aggressive behaviour.
• Also can cause epilepsy and progressive disorders such as Parkinson's
disease in the long term.
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