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but the available data do not justify such an assumption In schizophrenic patients, the areas activated during a period of active auditory hallucinosis include not only Heschl s gyri but also the hippocampus and other widely distributed structures in the dominant hemisphere (see Chap 58) Vestibular Disturbances 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 If this area is destroyed on one side, the only clinical effect may be an illusion that the environment is tipped on its side or is upside down; more often there is only subtle change in eye movements on optokinetic stimulation Epileptic activation of this area induces vertigo or a sense of disequilibrium As pointed out in Chap 15, pure vertiginous epilepsy does occur but is a rarity, and if vertigo precedes a seizure, it is usually momentary and quickly submerged in other components of the seizure Disturbances of Time Perception In a temporal lobe seizure originating on either side, time may seem to stand still or to pass with great speed On recovery from such a seizure, the patient, having lost all sense of time, may repeatedly look at the clock Assal and Bindschaedler have reported an extraordinary abnormality of time sense in which the patient invariably placed the day and date 3 days ahead of the actual ones There had been aphasia from a left hemispheral stroke years before, but the impairment of time sense occurred only after a left temporal stroke that also produced cortical deafness Certainly the most common disruptions of the sense of time occur as part of confusional states of any type The usual tendency is for the patient to report the current date as an earlier one, much less often as a later one Characteristically in this situation the responses vary from one examination to the next 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 Disturbances of Smell and Taste (See also Chap 12) The central anatomy and physiology of these two senses have been elusive Brodal concluded that the hippocampus was not involved However, seizure foci in the medial part of the temporal lobe (in the region of the uncus) often evoke olfactory hallucinations This type of uncinate t, as originally pointed out by Jackson and Stewart, is often accompanied by a dreamy state, or, in the words of Pen eld, an intellectual aura The central areas identi ed physiologically with olfaction are the posterior orbitofrontal, subcallosal, anterior temporal, and insular cortices, ie, the areas that mediate numerous visceral functions In comparison, hallucinations of taste are rare Stimulation of the posterior insular area elicited a sensation of taste along with disturbances of alimentary function (Pen eld and Faulk) There are cases in which a lesion in the medial temporal lobe caused both gustatory and olfactory hallucinations Sometimes the patient cannot decide whether he experienced an abnormal odor, taste, or both The anatomy and physiology of smell and taste are discussed further in Chap 12 Other (Nonauditory) Syndromes Between the hippocampal formation (on the inferomedial surface of the temporal lobe) and the primary and secondary auditory areas (Heschl s transverse gyri.

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and superior temporal convolution, respectively), there is a large inferolateral expanse of temporal lobe that has only vaguely assignable integrative functions With lesions in these parts of the dominant temporal lobe, a defect in the retrieval of words (amnesic dysnomia) has been a frequently observed abnormality Stimulation of the posterior parts of the rst and second temporal convolutions of fully conscious epileptic patients can arouse complex memories and visual and auditory images, some with strong emotional content (Pen eld and Roberts) The loss of certain visual integrative abilities, particularly face recognition (prosopagnosia), is usually assigned to lesions of the inferior occipital lobes as discussed further on, but the area implicated borders on the adjacent inferior temporal lobe as well Careful psychologic studies disclose a difference between the effects of dominant and nondominant partial (anterior) temporal lobectomy (Milner) With the former, there is dysnomia and impairment in the learning of material presented through the auditory sense; with the latter, there is impairment in the learning of visually presented material In addition, about 20 percent of patients who have undergone temporal lobectomy, left or right, show a syndrome similar to that which results from lesions of the prefrontal regions Perhaps more signi cant is the observation that the remainder of the cases show little or no defect in personality or behavior Disorders of Memory, Emotion, and Behavior Finally, attention must be drawn to the central role of the temporal lobe, notably its hippocampal and limbic parts, in memory and learning and in the emotional life of the individual As indicated earlier, these functions and their derangements have been accorded separate chapters Memory is discussed in Chap 21 and the neurology of emotion and behavior in Chap 25 To summarize, human temporal lobe syndromes include the following: 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 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.

drag and drop with the navigation pane context menus, which is part of the focus of this section The following two illustrations show the details of the context menu options; the first shows the context menu that appears when you right-click in the Rows area, and the second shows the context menu that appears when you right-click in the Columns area