Clinical Aspects of Temporo-Medial Lesions

Abstract

The clinical features most characteristic of temporo-medial lesions were recognized at the end of the last century. Sanders (1874) described taste sensations associated with epileptic seizures caused by a basal tumor invading the olfactory tract. Anderson (1887) highlighted the relationships between paroxysmal taste sensations or dreamy states and neoplasias situated in the anterior temporal lobe. In 1888 and 1890 Hughlings Jackson linked seizures involving intellectual aura, dreamy states and discrete motoric phenomena to lesions in the temporal lobe and introduced the term “uncinate seizure” to designate unpleasant olfactory sensations resulting from disorders in the uncal area. Within the timespan marked by these early reports and the introduction of modern neuroimaging, significant contributions have further delineated the clinical picture of temporal lesions. While it is impossible to give a detailed history of the literature on this topic, we should nevertheless remember the milestones leading to our present conceptualisation. In the Twenties Cushing stressed the localizing value of visual field deficits and Courville linked acoustic hallucinations to the posterior temporal region. A few years later, Kolodny reviewing a large series of temporal tumors, was the first to relate them to a syndrome including focal and generalized seizures, hemianopsia or quadranopsia, psychic alterations and speech disturbances.