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extension into the inferior eld in others Quadrantanopia from a dominant (left-sided) lesion is often combined with aphasia Bilateral lesions of the temporal lobes render a monkey psychically blind It can see and pick up objects but does not recognize them until they are explored orally Natural emotional reactions such as fear are lost This syndrome, named for Kluver and Bucy, has been identi ed only in partial form in humans (page 448) Lesser degrees of visual imperception have been uncovered in patients by Milner and by McFie and colleagues, using special tests Visual hallucinations of complex form, including ones of the patient himself (autoscopy), appear during temporal lobe seizures In stimulation studies, Pen eld was able to induce what he called interpretive illusions (altered impressions of the present) and to reactivate past experiences quite completely and vividly in association with their original emotions Temporal lobe abnormalities may also distort visual perception; seen objects may appear too large (macropsia) or small (micropsia), too close or far away, or unreal Some visual hallucinations have an auditory component: an imaginary gure may speak and move and, at the same time, arouse intense emotion in the patient The entire experience may seem unnatural and unreal but is unlike the visuospatial disorders of the body schema that are considered further on with disorders of the parietal lobe Cortical Deafness Bilateral lesions of the transverse gyri of Heschl, while rare, are known to cause a central deafness Henschen, in his famous review of 1337 cases of aphasia that had been reported up to 1922, found 9 in which these parts were destroyed by restricted vascular lesions, with resulting deafness There are now many more cases of this type in the medical literature; lesions in other parts of the temporal lobes have no effect on hearing These observations are the basis for the localization of the primary auditory receptive area in the cortex of the transverse gyri (chie y the rst) on the posterosuperior surface of the temporal lobe, deep within the sylvian ssure (areas 41 and 42) Subcortical lesions, which interrupt the bers from both medial geniculate bodies to the transverse gyri, as in the two cases described by Tanaka and colleagues, have the same effect With left-sided superotemporal lesions, there is usually an aphasia because of the proximity of the transverse gyri to the superotemporal association cortex He caen has remarked that cortically deaf persons may seem to be unaware of their deafness, a state similar to that of blind persons who act as though they could see (the latter is called Anton syndrome, as described further on) 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 de cits can be detected with careful testing If very brief auditory stimuli are delivered, the threshold of sensation is elevated in the ear opposite the lesion Also, while unilateral lesions do not diminish the perception of pure tones or clearly spoken words, the ear contralateral to a temporal lesion is less ef cient if the conditions of hearing are rendered more dif cult (binaural testing) For example, if words are slightly distorted (electronically ltered to alter consonants), they are heard less well in the ear contralateral to the lesion In addition, the patient has more dif culty in equalizing the volume of sounds that are presented to both ears and in perceiving rapidly spoken numbers or different words presented to the two ears (dichotic listening) Auditory Agnosias Lesions of the secondary (unimodal association) zones of the auditory cortex area 22 and part of area 21.

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have no effect on the perception of sounds and pure tones However, the perception of complex combinations of sounds is severely impaired This impairment, or auditory agnosia, takes several forms inability to recognize sounds, different musical notes (amusia), or words and presumably each has a slightly different anatomic basis In agnosia for sounds, auditory sensations cannot be distinguished from one another Such varied sounds as the tinkling of a bell, the rustling of paper, running water, and a siren all sound alike The condition is usually associated with word deafness (page 421 and below) or with amusia Hecaen observed an agnosia for sounds alone in only two cases; one patient could identify only half of 26 familiar sounds, and the other could recognize no sound other than the ticking of a watch Yet in both patients the audiogram was normal, and neither had trouble understanding spoken words In both, the lesion involved the right temporal lobe and the corpus callosum was intact Amusia proves to be more complicated, for the appreciation of music has several aspects: the recognition of a familiar melody and the ability to name it (musicality itself); the perception of pitch, timbre, and rhythm; and the ability to produce, read, and write music There are many reports of musicians who became worddeaf with lesions of the dominant temporal lobe but retained their recognition of music and their skill in producing it Others became agnosic for music but not for words, and still others were agnosic for both words and music According to Segarra and Quadfasel, impaired recognition of music results from lesions in the middle temporal gyrus and not from lesions at the pole of the temporal lobe, as had been postulated by Henschen Many other studies implicate the superior temporal gyrus in these de cits A loss of the ability to perceive and produce rhythm may or may not be associated In any case, the temporal lobe opposite that responsible for language (ie, the right) is implicated in almost all cases That the appreciation of music is impaired by lesions of the nondominant temporal lobe nds support in Milner s studies of patients who had undergone temporal lobectomy She found a statistically signi cant lowering of the patient s appreciation of the duration of notes, timbre, intensity of sounds, and memory of melodies following right temporal lobectomy; these abilities were preserved in patients with left temporal lobectomies, regardless of whether Heschl s gyri were included Shankweiler had made similar observations, but in addition found that patients had dif culty in denominating a note or naming a melody following left temporal lobectomies More recent observations permit somewhat different interpretations Tramo and Bharucha examined the mechanisms mediating the recognition and discrimination of timbre (the distinctive tonal quality produced by a particular musical instrument) in patients whose right and left hemispheres had been separated by callosotomy They found that timbre could be recognized by each hemisphere somewhat better by the left hemisphere than by the right Also, it was observed that lesions of the right auditory cortex impaired the recognition of melody (the temporal sequence of pitches) and of harmony (the sounding of simultaneous pitches) However, if words were added to the melody, then either a left- or right-sided lesion impaired its recognition (Samson and Zatorre) From functional imaging studies, it appears that the left inferior frontal region is activated by tasks that involve the identi cation of familiar music (Platel et al), as if this were a semantic test, but passively listening to melodies activates the right superior temporal and occipital regions (Zatorre et al).

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