Extratemporal Lesions Triggering the Temporal-Lobe Syndrome

I N 1961 the authors and their associates 32 published a paper on hallucinations of the tempora l and occipital lobe triggered f rom lesions of the frontal lobe. Emphasis was placed upon the importance of the anatomical interrelationships of the frontal and the temporal lobes through the uncinate fasciculus. One case presented in tha t paper will be reviewed here so t ha t the complete neurological pa t t e rn m a y be described and emphasized. This pa t ien t had formed visual hallucinations in the right homonymous field. These consisted of headless persons with arms of bizarre shape a t t ached to their necks, br ight ly colored butterflies, circles, and bars. All of these objects were in the r ight visual field. She also had audi tory hallucinations, hearing whistling noises like the sound of a wind. Such audi tory hallucinations are present when irr i tat ing lesions are located in midport ions of the superior temporal gyrus. Simultaneously there were olfac tory hallucinations in which she smelled foul cigar smoke. These olfactory hallucinations are characterist ic features of uncinate a t tacks . The pa t ien t ' s electroencephalogram demonst ra ted an abnormal pa t t e rn with high-voltage delta waves bi lateral ly in the prefrontal , in the left anter ior temporal , and, to a lesser degree, in the left mid tempora l and the occipital regions (Fig. 1). However , the lesion responsible for these various hallucinations was an abscess a t the t ip of the left f rontal lobe. After the excision