The temporal lobe includes structures important for processing sensory information like sound, vision, and smell. It also plays a key role in memory, emotion, and behavior. The amygdala, hippocampus, cingulate gyrus, and their connections are part of the limbic system and are involved in processing emotions. The amygdala in particular helps associate emotions with memories and sensory experiences. Damage to different parts of the temporal lobe can cause deficits in language, hearing, vision, smell, and affect memory and emotional processing.

3.  The temporal lobe includes the superior, middle, and
inferior temporal, lateral occipitotemporal, fusiform,
lingual, parahippocampal, and hippocampal
convolutions and the transverse gyri of Heschl
 Heschl gyri -constitute the primary auditory receptive
area and are located within the sylvian fissure
 The cortical receptive zone for labyrinthine impulses
is less well demarcated than the one for hearing but is
probably situated on the inferior bank of the sylvian
fissure, just posterior to the auditory area

4.  The superior part of the dominant temporal lobe is
concerned with the acoustic or receptive aspects of
language
 The middle and inferior convolutions are sites of
visual discriminations; they receive fiber systems
from the striate and parastriate visual cortices and,
in turn, project to the contralateral visual
association cortex, the prefrontal heteromodal
cortex, the superior temporal cortex, and the
limbic and paralimbic cortex
 Presumably these systems subserve such functions
as spatial orientation, estimation of depth and
distance, stereoscopic vision, and hue perception

5.  The most important functions of the hippocampus
and other structures of the hippocampal formation
(dentate gyrus, subiculum, entorhinal cortex, and
parahippocampal gyrus) are in learning and
memory
 There is an abundance of connections between the
mediotemporal lobe and the entire limbic system

6.  Physiologically, two functional correlations stand
out—that the temporal lobe is the great integrator
of ―sensations, emotions, and behavior‖ (Williams)
and that it is continuously active throughout life
 The temporal lobe seems to be the site where
sensory modalities are integrated into ultimate
self-awareness

7.  Disorders of special senses (visual, auditory,
olfactory and gustatory)
 Time perception
 Language
 Memory
 Emotion and behaviour

8.  Superior homonymous quadrantanopia-not
congruent
 Kluver bucy syndrome-bilateral lesions of temporal
lobes
 Visual hallucinations of complex type including
autoscopy-temporal lobe seizures

9.  Bilateral lesions of the transverse gyri of Heschl,
while rare, are known to cause a central deafness
 Unilateral lesions of Heschl’s gyri were for a long
time believed to have no effect on hearing; it has
been found, however, that a number of subtle
deficits can be detected with careful testing

10. Agnosia of sounds
Amusia
Auditory verbal agnosia

11.  Agnosia for sounds-auditory sensations cannot be
distinguished from one another
 Usually associated with word deafness or amusia
 Lesion involved right temporal lobe in isolated
cases-Hecaen

12.  Amusia -the nondominant hemisphere is important
for the recognition of harmony and melody (in the
absence of words), but that the naming of musical
scores and all the semantic (writing and reading)
aspects of music require the integrity of the
dominant temporal and probably the frontal lobes
as well
 Word deafness-essential element of wernickes
aphasia

13.  They may be elementary or complex
 In temporal lobe epilepsy, the auditory
hallucinations are known to occur alone or in
combination with visual or gustatory hallucinations,
visual distortions, dizziness, and aphasia
 There may be hallucinations based on remembered
experiences (experiential hallucinations)

14.  Elementary hallucinations and dreamy states have
been reported with lesions of either temporal lobe,
whereas the more complex auditory hallucinations
and particularly polymodal ones (visual plus
auditory) occur more often with left-sided lesions
 Complex but unformed auditory hallucinations
(e.G., The sound of an orchestra tuning up), as well
as entire strains of music and singing, occur with
lesions that appear to be restricted to the pons
(pontine auditory hallucinosis)

15.  In the superior and posterior part of the temporal
lobe (posterior to the primary auditory cortex),
there is an area that responds to vestibular
stimulation by establishing one’s sense of
verticality in relation to the environment
 The only clinical effect may be an illusion that the
environment is tipped on its side or is upside down
 Epileptic activation of this area induces vertigo or a
sense of disequilibrium

16.  In a temporal lobe seizure originating on either
side, time may seem to stand still or to pass with
great speed
 The most common disruptions of the sense of
time occur as part of confusional states of any type
 The patient with a Korsakoff amnesic state is
unable to place events in their proper time
relationships, presumably because of failure of
retentive memory, a function assignable to the
medial temporal lobes

17.  Seizure foci in the medial part of the temporal lobe
(in the region of the uncus) often evoke olfactory
hallucinations
 This type of ―uncinate fit,‖ as originally pointed out
by jackson and stewart, is often accompanied by a
dreamy state, or, in the words of penfield, an
―intellectual aura‖
 Hallucinations of taste are less common

18. I. Effects of unilateral disease of the dominant temporal
lobe
A. Homonymous upper quadrantanopia
B. Wernicke’s aphasia (word-deafness—auditory verbal agnosia)
C. Amusia (some types)
D. Impairment in tests of verbal material presented through the auditory sense
E. Dysnomia or amnesic aphasia
F. Visual agnosia
G. Occasionally amnesic (Korsakoff) syndrome
II. Effects of unilateral disease of the nondominant
temporal lobe
A. Homonymous upper quadrantanopia
B. Inability to judge spatial relationships in some cases
C. Impairment in tests of visually presented nonverbal material
D. Agnosia for sounds and some qualities of music
contd.,

19. III. Effects of disease of either temporal lobe
A. Auditory, visual, olfactory, and gustatory hallucinations
B. Dreamy states with uncinate seizures
C. Emotional and behavioral changes
D. Delirium (usually nondominant)
E. Disturbances of time perception
IV. Effects of bilateral disease
A. Korsakoff amnesic defect (hippocampal formations)
B. Apathy and placidity
c.Kluver-Bucy syndrome

21.  Emotion defined as any strong feeling state—e.g.,
fear, anger, excitement, love, or hate—associated
with certain types of bodily changes (mainly
visceral and under control of the autonomic
nervous system) and leading usually to an impulse
to action or to a certain type of behavior
 The components of emotion appear to consist of
◦ (1) the perception of a stimulus, which may be internal (an
idea) or external,
◦ (2) the feeling,
◦ (3) the autonomic-visceral changes,
◦ (4) the outward display of affect, and
◦ (5) the impulse to a certain type of activity.

22. ―The hypothalamus, the anterior thalamic nucleus, the cingulate gyrus,
the hippocampus and their interconnections, constitute a harmonious
mechanism which may elaborate the functions of central emotion as
well as participate in the emotional expression.‖ -James Papez, 1939
 Broca, Papez, Kluver and Bucy
 Parts of the brain underlying
emotional behavior
 Associated with the olfactory
system; rhinencephalon = ―smell
brain‖
http://www.hallym.ac.kr/~de1610/nana/chp-12n.htm#II

23. ANATOMY
 Identified medial
surface of cerebrum
that are different
from the rest of
cortex—called it
border=limbic lobe
 Cortex surrounding
corpus callosum
 Thought to be
involved in olfaction

24.  Paul Broca (1824-1880):
1878: ―le grand lobe limbique‖
Refers to a ring of gray matter on the medial
aspect of the cerebral hemispheres
 James Papez (1883-1958):
1930’s: defined a limbic system that might
underlie the relationship between emotion and
memory (Papez’ circuit).

25.  James Papez 1930s identified limbic structures
involved in emotion (added the thalamic structures
to the limbic lobe)
 Cingulate cortex to hippocampus to hypothalamus
via the fornix and from hypothalamus to anterior
nuclei of thalamus
 Neocortex connects to cingulate cortex
 Allows one to experience emotion

28. o Amygdaloid body
o Hippocampus (―seahorse‖)
o Cingulate gyus
o Parahippocampal gyrus
o Hypothalamus
o Mamillary bodies
o Anterior nucleus of thalamus

29.  ―Emotional brain
o Emotional and motivational aspects of behavior.
o Provides emotional component to learning process:
Especially the amygdala
 Associated with memory
o Especially the hippocampus
 Associated with pain/pleasure, rage

30.  Greek name for almond shape
 Neurons at the pole of the temporal lobe below the
cortex on the medial side
 Has 3 nuclei, basolateral, corticomedial and central
 Afferents from all lobes of neocortex &
hippocampus and cingulate gyrus

32.  Basolateral
◦ Similar to cortex
◦ Projects to ventral striatum
◦ Has pyramidal like cells
◦ Receives input from primary sensory cortex, polysensory cortex and
thalamus
◦ Connections are reciprocal
 Cortical
◦ Olfactory amygdala
◦ Receives direct input form olfactory system, both the olfactory bulb and
olfactory cortex
 Central Medial group
◦ Main output of amygdaloid complex
◦ Input from hippocampus, orbitofrontal, insula, anterior cingulate cortex as
well as basolateral group
◦ Projects to hypothalamus, brainstem via stria terminalis and
amygdaloventral fugal pathway
◦ Part of ―central autonomic network‖

33.  Basolateral nuclei receive sensory input (visual,
gustatory, auditory and tactile); also projects to cortex
for perception of emotion
 Corticomedial nuclei receive olfactory inputs
 Central nuclei contain output neurons to
hypothalamus and periaqueductal grey in brainstem
for physiological responses

35.  Decreases emotional response
 Kluver-Bucy Syndrome=reduced emotionality
 Fearlessness
 Cannot recognize emotional expressions on faces
that are fearful, anxious & angry but recognize
happy & disgust
 Bilateral amygdala removal reduces memory

36.  Cause affective rage when basalateral nuclei is
stimulated
 Corticomedial stimulation reduces aggression

37.  Require the amygdala and work through 2
pathways.
 Integrate information from all sensory systems
and orchestrate the physiological and psychological
response
◦ Ventral amygdofugal pathway
◦ Stria terminalis

38.  Androgen levels in males can
alter aggressive behaviors
 Predatory aggression:
purpose is getting food, little
sympathetic NS activity
◦ Medial hypothalamus
 Affective aggresion: purpose
is scare off
enemies/protection
◦ Lateral hypothalamus

40.  Autonomic nuclei in the brainstem receive synaptic
input from hypothalamus via
◦ Medial forebrain bundle
◦ Dorsal longitudinal fasciculus

41.  Depending on area, animal shows different
behaviours
 Associated with eating, sniff & eat
 Associated with fear or anger
 Demonstrates 2 functions of hypothalamus
◦ Metabolic regulation; homeostasis
◦ Coordinated somatic & visceral responses

42.  Serotonin containing neurons located in Raphe
nucleus in brainstem that project via medial
forebrain bundle to hypothalamus & other
limbic structures
 Aggressive mice have decreased serotonin
turnover
 Drugs that block serotonin release or synthesis
cause increase in aggression

43.  Greek: ―Sea Monster‖
 Another terminology mess
◦ Allocortex/ archicortex
◦ Hippocampal formation (after Amaral and
Witter)
 Dentate gyrus
 Hippocampus proper ―Cornu ammonis‖
 Subicular complex
 Subiculum
 Presubiculum
 parasubiculum
 Entorhinal cortex

44.  Greek: ―Sea Monster‖
 Another terminology mess
◦ Allocortex/ archicortex
◦ Hippocampal formation (after Amaral and
Witter)
 Dentate gyrus
 Hippocampus proper ―Cornu ammonis‖
 Subicular complex
 Subiculum
 Presubiculum
 parasubiculum
 Entorhinal cortex

45. •Afferents:
•Much of cortex is reciprocally connected to entorhinal cortex
•Cholinergic and GABA input via septal nuclei
•Amygdala
•VTA, LC, Raphe
•Efferents
•Via the fornix
•Precommissural: septal nuclei
•Post-commisural: mammillary bodies (to anterior
thalamic nucleus via mammillothalamic tract)

46.  James Lange Theory 1884
 Experience emotions IN RESPONSE to
physiological changes in our body

47.  1927: Emotional experience can occur
independently of emotion expression
 Transect animal spinal cord and emotional
expression observed
 Removal or damage to somatic sensory
system does not diminish emotion
experience.

49.  I. Disturbances of emotionality due to:
◦ A. Perceptual abnormalities (illusions and hallucinations)
◦ B. Cognitive derangements (delusions)
 II. Disinhibition of emotional expression
◦ A. Emotional lability
◦ B. Pathologic laughing and crying
 III. Rage reactions and aggressivity
 IV. Apathy and placidity
◦ A. Kluver-Bucy syndrome
◦ B. Other syndromes (frontal and thalamic)
 V. Altered sexuality
 VI. Endogenous fear, anxiety, depression, and euphoria

50.  Delirium -Threatened by imaginary figures and
voices that seem real
 The patient’s affect, emotional reaction, and
visceral and somatic motor responses are
altogether appropriate to the content of the
hallucinations
 There also occurs a state of overwhelming
emotionality in patients who are in severe acute
pain

51.  Emotional lability is a sign of organic brain disease
 In this type of emotional disturbance, the response,
while excessive, does not reach the degree of
forced emotionality of the special form of lability
described as pseudobulbar furthermore, it is
appropriate to the stimulus and the affect is
congruent with the visceral and motor components
of the expression.

52.  This form of disordered emotional expression,
characterized by outbursts of involuntary,
uncontrollable, and stereotyped laughing or crying
 The term emotional incontinence applied by
psychiatrists
 Forced laughing and crying always has a pathologic
basis in the brain, either diffuse or focal

53.  Bilateral strokes (lacunes in the cerebral hemispheres
or pons most often, and after several strokes in
succession)
 Binswanger diffuse leukoencephalopathy
 Amyotrophic lateral scerlosis with pseudobulbar palsy
 Progressive supranuclear palsy
 Multiple sclerosis with bilateral corticobulbar
demyelinative lesions
 Bilateral traumatic lesions of the hemispheres
 Hypoxic-ischemic encephalopathy
 Pontine myelinolysis
 Wilson disease

54.  In this state there is often a striking incongruity
between the loss of voluntary movements of
muscles innervated by the motor nuclei of the
lower pons and medulla and the preservation of
movement of the same muscles in yawning,
coughing, throat clearing, and spasmodic laughing
or crying (i.e., in reflexive pontomedullary
activities)

55.  In such cases, on the slightest provocation and
sometimes for no apparent reason, the patient is
thrown into a stereotyped spasm of laughter that
may last for many minutes, to the point of
exhaustion
 But more often, the opposite happens—the mere
mention of the patient’s family or the sight of the
doctor provokes an uncontrollable spasm of crying

56.  The severity of the emotional incontinence or the
ease with which it is provoked does not always
correspond with the severity of the pseudobulbar
paralysis or with an exaggeration of the facial and
masseter (―jaw jerk‖) tendon reflexes

57.  Descending motor pathways which naturally inhibit
the expression of the emotions were interrupted-
Wilson
 Supranuclear pathways are involved somewhere in
the brainstem between thalamus and medulla and
lesions are bilateral in practically all instances-
Poeck

58.  Rage reactions of may be encountered in the
following medical settings
1.Temporal lobe seizures
2.Sociopaths
3.Acute or Chronic neurological disorders
4.Metabolic or toxic encephalopathies

59.  Temporal lobe seizures-a directed attack of
uncontrollable rage may occur either as part of a
seizure or as an interictal phenomenon
-Gastaut
 Lesser degrees of aggressive behaviour are more
common-brief in duration and poorly directed

60.  Acute neurological disorders-Hemorrhagic
leukoencephalitis, lobar hemorrhage, infarction,
and herpes simplex encephalitis affecting the
medio-orbital portions of the frontal lobes and
anterior portions of the temporal lobes may cause
rage reactions
 Outbursts of Rage can be seen with temporal lobe
gliomas

61. KLUVER-BUCY SYNDROME
In 1939, Kluver and Bucy described a behavioural
syndrome in rhesus monkeys that followed
bilateral temporal lobectomy
Manifestations –
1.Hypersexuality
2.Excessive oral tendencies
3.Loss of normal fear and anger
4.Hypermetamorphosis
5.Psychic blindness
6.Dietary changes

62.  In 1955 Terzian first reported the same syndrome in
humans after bilateral temporal lobectomy
 Causes-
1.Herpes encephalitis
2.Picks disease
3.Alzheimer disease
4.Cerebrovascular accidents
5.Cerebral trauma
6.temporal lobe epilepsy
 The common feature of all etiologies was bilateral
mesial temporal lobe destruction or dysfunction

63.  Hypersexuality –indiscriminate sexual behaviour-seen with
orbitofrontal lesions and loss of sexual drive seen with
superior frontal lesions
 In rare cases, extreme hypersexuality marks the onset of
encephalitis or develops gradually with tumors of the
temporal region. Possibly the limbic parts of the brain are
disinhibited, the ones from which MacLean and Ploog could
evoke penile erection and orgasm by electrical stimulation
(medial dorsal thalamus, medial forebrain bundle, and septal
preoptic region).
 In clinical practice, the commonest cause of disinhibited
sexual behavior, next to the aftermaths of head injury and
cerebral hemorrhage, is the use of dopaminergic drugs in
Parkinson disease.

64.  Hyposexuality -most often due to a depressive
illness
 Drugs -antihypertensive, anticonvulsant,
serotoninergic antidepressant, and neuroleptic
drugs
 Sexual arousal as an ictal phenomenon is apt to
occur in relation to temporal lobe seizures,
particularly when the discharging focus is in the
mediotemporal region

65.  Depression is less frequent as an ictal emotion,
although it occurs often enough as an interictal
phenomenon (Benson et al)
 Odd mixtures of depression and anxiety are often
associated with temporal lobe tumors and less
often with tumors of the hypothalamus and third
ventricle
 Elation and euphoria are less well documented as
limbic phenomena

66.  The phenomenon of acute fear and anxiety
occurring as a prelude to or part of a seizure
 neuronal circuits subserving fear are coextensive
with those of anger; both are thought to lie in the
medial part of the temporal lobe and amygdala
 Destruction of the central part of the amygdaloid
nuclear complex abolishes fear reactions. These
nuclei are connected to the lateral hypothalamus
and midbrain tegmentum

67. Thank you