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
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
20.
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
26.
27.
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
31.
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
34.
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
39.
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
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.
48.
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
