Summary
Unilateral dominant hemisphere | Unilateral non-dominant hemisphere | Either temporal lobe | Bilateral disease |
- Homonymous upper quadrantanopia - Wernicke's aphasia - Amusia - Anomia - Visual agnosia - Impairment on tests of visually presented material | - Homonymous upper quadrantanopia - Agnosia for sounds & some qualities of music - Impairment on tests of visually presented material | - Auditory, visual, olfactory hallucinations - Dreamy states - Emotional & behavioural changes - Delirium - Disturbance of time perception | - Korsakoff amnesic defect - Apathy & palcidity - Klüver–Bucy syndrome |
Klüver–Bucy syndrome
- Bilateral lesions of the medial temporal lobe (including amygdaloid nucleus)
- Clinical features
- "Placidity" or "tameness".
- Docility, characterized by exhibiting diminished fear responses or reacting with unusually low aggression.
- Dietary changes and hyperphagia,
- Characterised by eating inappropriate objects (pica)
- Overeating
- Both
- Hyperorality
- described by Ozawa et al. as "an oral tendency, or compulsion to examine objects by mouth"
- Hypersexuality
- Heightened libido or a tendency to seek sexual stimulation from unusual or inappropriate objects
- Visual agnosia
- Inability to recognize familiar objects or people.
- Pathology
- Damage to temporal sections of the limbic networks, which connects to other structures that regulate emotional behaviour
- Muller theory
- attributes Klüver–Bucy syndrome to the disconnection of pathways used for emotional regulation and memory, such as those connecting the dorsomedial thalamus to the prefrontal cortex.
- The medial temporal sections of the limbic system can be associated with more primitive functions such as reproduction, food, and defence.
- This can be seen in the symptoms of increased hypersexuality, hyperorality, and general aggression
Wernickes Aphasia
- See Speech
- Also known as Fluent / Recepetive / Sensory / Postrolandic Aphasia
- Due to
- destruction of posterior superior temporal area of the dominant hemisphere supplied by inferior division of MCA.
- Features
- Fluency is preserved with a normal or even increased word output (Logorrhea)
- Speech although effortless is devoid of meaningful content
- Paragrammatism (jargon aphasia)
- Paraphasias, Neologisms and defective sentence structure
- Auditory comprehension is impaired, even unaware of his own speech, and doesnot correct himself.
- Repetition impaired
- Reading impaired
- Naming impaired
- Writing impaired
- Patient often is unaware of the defect
Temporal lobe epilepsy / psychomotor seizures
- Due to
- Lesions involving medial temporal lobe in the region of Uncus
- Aka Uncinate Fits which involve olfactory hallucination also
- Seizures may present as
- Automatisms
- Illusions and hallucinations
- Visual hallucinations are complex with image distortion (macropsia /micropsia / near / far)
- May have an auditory component
- Pilomotor erections.
- Amnesia for the event is usually seen.
- Déjä Vu (already seen)
- Jamais Vu (something familiar is strange or new)
- Deja Pensee/Deja Vacu (something new seeming strangely familiar)
- Experiential hallucinations (Hallucinations based on remembered experiences)
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