The Temporal Lobes When fe was 40 years old, H. H., a successful corporate lawyer with a wite and Ind school-age children, was finding his job increasingly stressful. His wife was taken ef guard when he suddenly announced that he was quitting his law firm, He complained dl being so stressed that he simply could not remember cases on which he was working and felt that he could not continue as a lawyer. He had na plar about how he would suppor his family but, curiously, he seemed unconcerned about it ‘A couple weeks ‘ater, H. H. shaved his hair ff, donned a flowing robe, and left hi family to join a fringe religious group. His wife of 15 years was stunned by this sud cchange in behavior: up to this point, H. H. had been an atheist, She was notified a ca ple of weeks later that he had collapsed with a seizure while handing out flowers and eace pamphlets in a large U.S. airport. He was taken to a hospital in a confused stat ‘and a neurological examination revealed a lef-temporal-labe tumor. Fortunately, it wal operable and was removed, HH was aphasie after his surgery, but this condition cleared in a matter of wee He was left with enduring word-finding dificultis, probiematic only when he was tel He continued to complain of verbal memory probiems, however. And his wife said that personality remained diferent from what it had been, largely because he remained rl gious, Eventually, H. H. successfully returned to hic faw firm, although with a reduc caseload from that of his pretumor days H. showed typical symptoms of temporal-lobe disorder, including rad cal changes in affect and personality, memory disturbance, and at leat ‘transient disturbance of language. In this chapter, we survey the anatomy of temporal lobe, present a theoretics! mociel of its function, describe the symptoms of damage to it, and briefly describe clinical tests of temporal Function,Cuaprer 15 Tue Temvorat Loses 371 Anatomy of the Temporal Lobe The temporal lobe comprises all the tissue that lies below the Sylvian sul= cus and anterior to the occipital coed cortex (Figure 15.1). Subcortieal tem- Tatiana poral-lobe structures include the lim= one ne bic corvex, the amygdala, and the _ hippocampal formation (Figure 15.2). Figure 15.1 Gross anatomy ofthe Connections to and from the tempo- j feporlbe, (Te tee maj et ral lobe extend throughout the brain, vise theater sce ofthe eo shou ‘noosa ee. (8) Badmams claret meso theater es 5c. reas 20,21, and 3 Subdivisions of the Temporal Cortex che iret bin are Brodmann identified 10 temporal areas, but many more areas in the monkey Bally’ designation TE. () The gy were identified in more-recent studies (see Felleman and van Essen’s map, _vsleon amedial vi ofthe Figure 10.19). Likely there are more areas in the human as well. Wecan divide temporal be. Te uneus eters tothe the temporal regions on the lateral surface into those that are auditory eee eee (Brotmann’s areas $1, 42, and 22 in Figure 15.1B) and those that form the wen-_jiuges sae a tel visual stream on the lateral temporal lobe (areas 20, 21, 37, and 38 in Figure 15.1B). The visual regions are often referred to as inferotemporal cor- texor by von Economo’s designation, TR. Figure 125.2 viral stcture of tetera! bel aera ven cf the et henisphs illustrating ta eaive postions othe ayla 2a hippocampus bred dep inte temporal be. Te vical ines ‘al Hipaesgal Fuster interar indicate he appramat cation ofthe sections in the baton terpaal gyn ayus. temps illustration. (ato) rofl satin trough the let heisphere ovat ams illustrating th catia ane subcortical regins fhe tempor lobe.312 Parr Ill Corvscar Functions 1A) Brodmann’ areas ‘Auditory areas are light blue ‘and visual areas are dark blue. Boileys areas = Supa tanga sales Figure 15.3 oyoarntestone regions of the temporal cre a the tesus nk (A) Bredmanns areas. (8) Von Bonin ad Balle’ areas. (and) Lateral and veal views of Slizr and Pantya’s parclation showing the multinadal axeasin the super tmgaral suleus. The sueus has ben opened up toreveal may subareas on ts banks. These subareas are rxmaly rot visible ote surtace. ‘The sulci of the temporal lobe contain a lot of cortex, as can be seen in Figure 15.2. In particular, the Sylvian fissure contains tissue forming the fasta, which includes the gusta- tory cortex as well as the auditory association cortex. The supetior temporal sulcus, which separates the superior and middle tempor gyri, also contains a significant amount of Thehenig ef eadanhire ——neocorcex, which ean be dvked into may F subregions (Figure 15.3). ‘The cortex of the soba tal Superior temporal sulcus is mulmodal, 1 ceiving input from auditory, visual, and so- atic regions, as well as from the other ‘vo polymodal regions (frontal and parietal) and the paralimbic cortex. ‘The medial temporal region (limbic cor tex) includes the amygdala and adjacent cortex (uncus), the hippocampus and sur. rounding cortex (subiculum, entorhinal eor tex, perithinal cortex), and the fusiform gyrus. The entorhinal cortex is Brodmann’ area 28, and the perirhinal cortex comprises Brodmann’s areas 35 and 36. Cortical areas ‘TH and TF at the posterior end of the temporal lobe are often referred 0 as the parahippocempal cortex (see Figure 15.3). The fusiform gyrus and infe- rior temporal gyrus are fenetionally part of the lateral temporal cortex (see Figure 15.2) Connections of the Temporal Cortex The temporal lobes are rich in internal connections, afferent projections from te sensory systems, and efferent projections to the parietal and frontal associ- ation regions, limbic system, and basal ganglia. The neacortex of the left and right temporal lobes is connected by the corpus callosum, whereas the media temporal corcex and amygdala are connected by the anterior commissure. ‘The results of studies on the temporal-cortical connections of the monkey reveal five distinct types of cortical-cortical connections, whick are illustrated in Figure 15.4 1. A hierarchical sensory pathway. The hierarchical progeession of connections emanate from the primary and secondary auditory and visual areas, ending in the temporal pole. The visual projections form the ventral stream of visual processing, whereas the auditory projections form a parallel ventral stream of auditory processing (see Figure 15.44). - A dorsal auditory pathroay. Teaveling from the auditory areas to the posterior parietal cortex, this pathway is analogous o the dorsal visual pathway and thus concerned with directing movements with respect to auditory information (see Figure 15.44).