IV. Temporal lobe injury the right hemisphere (in right-handers) may not give distinct symptoms. Nevertheless, in most cases it is possible to establish some symptoms of prolapse or irritation, characteristic of both hemispheres. quadrant hemianopia, passing gradually with progressive processes into a complete hemianopia of the same name in opposite visual fields, is sometimes one of the early symptoms of damage to the temporal lobe. The cause of quadrant hemianopsia lies in the incomplete defeat of the fibers of the Graciole bundle (radiatio optica). Ataxia, more pronounced (like the frontal) in the trunk, causing mainly disorders of standing and walking. deviations of the body and a tendency to fall backwards and to the side, often opposite to the affected hemisphere. slipping inside in the hand opposite to the hearth. Atactic disorders in processes in the temporal lobe arise as a result of damage to those areas from where the occipital-temporal path of the bridge (tractus corticopontocerebellaris) begins, connecting the temporal lobe with the opposite hemisphere of the cerebellum.

Auditory, olfactory and gustatory hallucinations which are sometimes the initial symptom (“aura”) of an epileptic seizure, are manifestations of irritation of the corresponding analyzers localized in the temporal lobes. The destruction of these sensitive zones (one-sided) does not cause noticeable disorders in hearing, smell and taste (each hemisphere is connected with its perceiving apparatus on the periphery on both sides - its own and the opposite).

bouts of vestibular-cortical vertigo, accompanied by a feeling of violation of the spatial relationships of the patient with surrounding objects; often a combination of such dizziness with auditory hallucinations (hums, noises, buzzing).

Unlike lesions in the right hemisphere, lesions in left temporal lobe(in right-handers) often entail severe disorders.

The most common symptom is sensory aphasia, resulting from the defeat of Wernicke's area, located in the posterior part of the superior temporal gyrus. The patient loses the ability to understand speech. Heard words and phrases are not associated with their corresponding representations, concepts or objects; the patient's speech becomes incomprehensible in exactly the same way as if they were speaking to him in a language unfamiliar to him. It is extremely difficult to establish contact with such a patient through speech: he does not understand what they want from him, what he is asked for and what is offered to him. At the same time, the patient's own speech is also disturbed. Unlike a patient with motor aphasia, patients with Wernicke's area can speak and are often over-talkative and even talkative, but speech becomes irregular; instead of the desired word, another is erroneously pronounced, letters are replaced or words are placed incorrectly. In severe cases, the patient's speech becomes completely incomprehensible, representing a meaningless set of words and syllables ("salad of words"). Violation of the correctness of speech, despite the safety of Broca's area, is explained by the fact that as a result of the defeat of Wernicke's area, control over one's own speech falls out. A patient with sensory aphasia does not understand not only someone else's speech, but also his own: hence a number of errors, irregularities, etc. (paraphasia). The patient does not notice defects in his speech. If a patient with motor aphasia is annoyed with himself and his helplessness in speech, then a patient with sensory aphasia is sometimes annoyed with people who cannot understand him.

Another very peculiar type of aphasia is amnestic aphasia - a symptom of damage to the posterior temporal and lower parietal lobe. With this disorder, the ability to determine the “name of objects” drops out. When talking with a patient, sometimes it is not immediately possible to notice a defect in his speech: he speaks quite freely, builds his speech correctly, and is understandable to others. Nevertheless, it is noticeable that the patient often "forgets" words and that his phrases are poor in nouns. The defect is detected immediately if you invite him to name objects: instead of the name, he begins to describe their purpose or properties. So, without naming the pencil, the patient says: “This is for writing”; about a piece of sugar: “What they put, interfere, is made sweet, they drink,” etc. When prompting the name of the patient, the patient confirms the correctness of it or rejects it if the item is named incorrectly. The patient explains his failures by the fact that he "forgot the name of this or that object" (hence the term - amnestic aphasia).

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When the posterior sensory root enters the spinal cord, only pain fibers .. damage to the posterior column of the spinal cord causes a loss of joint-muscular and vibrational sensation on the side ..

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The defeat of the temporal lobe (the right hemisphere in right-handers) is not always accompanied by severe symptoms, but in some cases symptoms of loss or irritation are detected. Quadrant hemianopsia is sometimes an early sign of damage to the temporal lobe of the cortex; its reason lies in the partial defeat of the fibers of the Graciole bundle. In the event that the process has a progressive character, it gradually transforms into a complete hemianopia of the opposite lobes of vision. Stylish cases for Samsung Note 2 in the sintos.ru store. Drop by.

Ataxia, as in the case of frontal ataxia, leads to disturbances in standing and walking, expressed in this case in a tendency to fall backwards and sideways (to the side opposite to the hemisphere with the pathological focus). Hallucinations (auditory, gustatory and olfactory) are sometimes the first signs of an epileptic seizure. They are actually symptoms of irritation of the analyzers located in the temporal lobes.

Unilateral dysfunction of the sensitive areas does not, as a rule, cause a significant loss of gustatory, olfactory or auditory sensitivity, since the cerebral hemispheres receive information from the peripheral perceiving apparatuses of both sides. Attacks of dizziness of vestibular-cortical genesis are usually accompanied by a feeling of violation of the patient's spatial relationships with the objects surrounding him; dizziness is often accompanied by auditory hallucinations.

The presence of pathological foci in the left temporal lobe (in right-handers) leads to severe disorders. When a lesion is localized in Wernicke's area, for example, sensory aphasia occurs, which leads to a loss of the ability to perceive speech. Sounds, individual words and whole sentences are not attached to the patient's concepts and objects known to him, which makes it almost impossible to establish contact with him. In parallel, the speech function of the patient himself is also impaired. Patients with a lesion localized in Wernicke's area retain the ability to speak; moreover, they even have excessive talkativeness, but speech becomes incorrect. This is expressed in the fact that words that are necessary in meaning are replaced by others; the same applies to syllables and individual letters. In the most severe cases, the patient's speech is completely incomprehensible. The reason for this complex of speech disorders is that control over one's own speech falls out. A patient suffering from sensory aphasia loses the ability to understand not only someone else's speech, but also his own. As a result, paraphasia occurs - the presence of errors and inaccuracies in speech. If patients suffering from motor aphasia are more annoyed by their own speech errors, then people with sensory aphasia are offended by those who cannot understand their incoherent speech. In addition, with the defeat of Wernicke's area, there are disorders in reading and writing skills.

If we carry out a comparative analysis of speech dysfunctions in pathologies of various parts of the cerebral cortex, then we can confidently state that the lesions of the posterior part of the second frontal gyrus are the least severe (associated with the impossibility of writing and reading); then comes the defeat of the angular gyrus, associated with alexia and agraphia; more severe - damage to Broca's area (motor aphasia); and finally, the defeat of Wernicke's area is distinguished by the most serious consequences.

Mention should be made of the symptom of damage to the posterior temporal and lower parietal lobes - amnestic aphasia, which is characterized by the loss of the ability to correctly name objects. In the course of a conversation with a patient suffering from this disorder, it is far from immediately possible to notice any deviations in his speech. Only if you pay attention, it becomes clear that the patient's speech contains few nouns, especially those that define objects. He says "sweets that are put in tea" instead of saying "sugar", while claiming that he simply forgot the name of the item.

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Auditory (acoustic) agnosia. Temporal neuropsychological syndromes differ depending on the side of the lesion due to the clear lateralization of the brain mechanisms of speech functions and occur when fields 42, 22 (secondary and tertiary) of the auditory analyzer are affected.

Types of auditory agnosia:
1. Speech acoustic agnosia. It is more commonly called sensory aphasia, since it is based on a violation of phonemic hearing, which provides a differentiated analysis of meaningful speech sounds. Sto”, the severity of agnosia can be different: from a complete inability to distinguish phonemes of the native language (native speech is perceived as a set of sounds without meaning) to difficulty understanding close phonemes, rare and complex words, speech at a fast pace or spoken in “difficult” conditions.
2. Auditory agnosia occurs when the nuclear zone of the auditory analyzer is damaged on the right. With this type of agnosia, the patient does not recognize the usual household, object and natural noises (creaking, the sound of pouring water, etc.).

2. Auditory agnosia occurs when the nuclear zone of the auditory analyzer is damaged on the right. With this type of agnosia, the patient does not recognize the usual household, object and natural noises (creaking, the sound of pouring water, etc.).

3. Arrhythmia - is expressed in the fact that patients cannot correctly "evaluate by ear" and reproduce rhythmic structures. When the right temple is damaged, the perception of the structural design of the rhythm as a whole is disturbed, when the left temple is damaged, the analysis and synthesis of the structure of the rhythm, as well as its reproduction.

4. Amusia manifests itself in a violation of the ability to recognize and reproduce a familiar or just heard melody.

5. Violation of the intonational side of speech (prosody) is expressed in the fact that patients do not distinguish intonations in the speech of others, in addition, their own speech is inexpressive: the voice is devoid of modulations and intonational diversity. This violation is typical for the temporal lesion.

6. Acoustic-mnestic aphasia. Occurs when the mediobasal parts of the cortex of the left temporal region are affected. The patient is unable to remember even a relatively small speech material due to impaired auditory-speech memory. As a result, there is a secondary, due to the weakness of the hearing of speech traces, a misunderstanding of oral speech.

The central symptom is a decrease in memory volume. The speed of processing verbal information also decreases.

Modal-nonspecific memory disorders. Occur when the mediobasal parts of the temporal region of the cerebral cortex are affected.

Defects in "general memory" manifest themselves in patients with difficulties in directly retaining traces of any modality. With more massive lesions of these parts of the brain, short-term memory impairment approaches the intensity of the Korsakoff syndrome (fixation amnesia, neurotic disorientation, paramnesia).

Emotional disorders. Occur when the mediobasal parts of the temporal cortex of the brain (limbic system) are affected.

With damage to the cortex of the right temporal lobe, two types of affective disorders are possible:
- paroxysms of excessive emotions with a hint of suffering (anguish, fear, horror), which may be accompanied by hallucinations and viscerovegetative changes;
- paroxysms, including the experience of derealization and depersonalization with a sharp decrease in emotionality or a euphoric background of mood.

Clinical observations of patients with left temporal lesions have shown that the leading factor here is the predominance of depressive-anxious experiences with activation and motor restlessness. Against the background of constant emotional stress and anxiety, alertness, suspicion, irritability, and conflict are increasingly manifested.

Disturbances of consciousness. Appear with damage to the medial parts of the temporal region of the brain. In severe cases, these are sleepy states of consciousness, confusion. In milder cases - difficulties in orientation in place, time (right hemisphere); absences.

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Frontal lobes: the anatomical and physiological characteristics of the frontal lobes with precentral gyri establishes a connection with, first of all, motor functions. Although the projection zone of the kinesthetic analyzer is located in the parietal lobe, part of the conductors of deep sensitivity ends in the precentral gyrus, thus. in this zone, the zones of the motor and skin analyzers overlap.

Violations: CENTRAL PARESIS AND PARALLIES - occur with localization of the focus in the precentral gyrus. Localization on the outer surface causes mainly paresis of the arm, facial muscles and tongue, and on the medial surface, mainly paresis of the foot. With damage to the posterior part of the second frontal gyrus, gaze paresis in the opposite direction(the patient looks at the lesion). There are also extrapyramidal disorders - hypokinesis, muscle rigidity, grasping phenomena - involuntary grasping objects. The reflexes of oral automatism are revived. With the defeat of the anterior parts of the frontal lobes, when there are no paresis, you can still notice the asymmetry of the face - mimic paresis of the facial muscles s, which is explained by a violation of the connections of the frontal lobe with the thalamus. C-m resistance occurs when the focus is localized in the extrapyramidal parts of the frontal lobes, manifested by involuntary tension of the antagonist muscles. S-m Kokhanovsky-involuntary tension of the circular muscle of the eye when trying to lift the upper eyelid. Frontal ataxia- a disorder of coordination of movement, trunk ataxia - the inability to stand and walk with the deviation of the body in the opposite direction. Frontal apraxia- incompleteness of actions, loss of purposefulness of actions. motor aphasia- with damage to the posterior part of the third frontal gyrus. Isolated agraphia- posterior part of the second frontal gyrus. Frontal psyche or apathico-abulic syndrome- patients are indifferent to the environment, the will to carry out voluntary movements suffers, criticism of their actions decreases, the tendency to flat jokes -moria, euphoria. Jacksonian focal seizures irritation of the precentral gyrus - one-sided convulsions on the opposite side. Adversive seizures - sudden convulsive turn of the head, eyes and whole body in the opposite direction indicates the localization of the focus in the extrapyramidal parts of the frontal lobe. General convulsive seizures with damage to the poles of the frontal lobes. Minor epileptic seizures- Sudden loss of consciousness for a short period of time.

Fallout Syndromes:

Anterior central gyrus motor center; contralateral linguofaciobrachial or monoparesis with unexpressed signs of central paresis; pseudo-peripheral; with irritation - Jacksonian epilepsy.

Premotor area: g emiparesis (with pronounced signs of pyramidal paresis, dissociated degree of severity in the arm and leg; with irritation - hemisomamotor seizures without a local onset with rapid secondary generalization).

Posterior sections of the middle frontal gyrus- cortical center of gaze; supranuclear ophthalmoplegia = gaze paresis, the impossibility of combined rotation of the eyeballs in the direction opposite to the focus, “looks at the focus”; agraphia; when irritated - adversive seizures, i.e. “looks at paretic limbs.”

Posterior sections of the inferior frontal gyrus dominant hemisphere - the motor center of Broca's speech; Efferent motor aphasia +/- agraphia. Dynamic motor aphasia middle region inferior gyrus)

Violation of the fronto-cerebellar connections - l general ataxia, astasia-abasia with a deviation in the opposite direction.

Damage to the extrapyramidal parts of the frontal lobes

Frontal parkinsonism (hemihypokinesia, decreased initiative, incentives to act)

Emotional paresis of mimic muscles

Symptoms of resistance (resistance, Kochanowski's symptom)

Oral automatism (Yanishevsky, "bulldog")

Grasping phenomena (Yanishevsky-Bekhterev, "magnetic hand").

Mediobasal divisions, olfactory, optic nerves: o unilateral hypo-, anosmia, Foster-Kennedy s-m, amblyopia, amaurosis, vegetative-visceral disorders. Frontal psyche - euphoric (decreased self-criticism, foolishness, moria, tactlessness, cynicism, hypersexuality, slovenliness). paroxysmal and permanent.

Front and middle sections:

Frontal apraxia, intent (violated initiation, sequence of actions, characterized by incompleteness, stereotypy, echopraxia)

The frontal psyche in case of damage to the convex is an apathetic-abulic syndrome (apathy, loss of initiative, weak will), paroxysmal and permanent.

Syndromes of irritation : Jacksonian epilepsy (anterior central gyrus), adversive seizures (fields 6.8), opercular epilepsy, generalized seizures (poles), attacks of frontal automatism. "Salute" seizures ("swordsman's posture"). Absences.

Parietal lobes. Postcentral gyrus: here the afferent pathways of skin and deep sensitivity end, the analysis and synthesis of perceptions from the receptors of surface tissues and organs of movement is carried out, in case of damage, the functions of the skin and motor analyzers are impaired. Most of the postcentral gyrus is occupied by the projection of the face, head, hand and fingers.

Violations: ASTEREOGNOSIS: unrecognition of objects when palpating them with closed eyes, occurs when the upper parietal lobule is damaged, next to the postcentral gyrus. With the defeat of the middle part of the post-gyrus, all types of sensitivity for the hand fall out, so the patient not only cannot recognize the object, but also describe its various properties - false astereognosis. Apraxia is a disorder of complex actions with the preservation of elementary movements, the result of damage to the parietal lobe of the dominant hemisphere and are detected during the actions of the limbs (usually hands) on both sides. Foci in the region of the supramarginal gyrus cause kinesthetic apraxia, and in the area of the angular gyrus - the decay of the spatial orientation of actions - spatial or constructive apraxia. AUTOPAGNOSIA: Failure to recognize or distort the perception of parts of one's body. PSEUDOMELIA: Feeling of an extra limb. ANSOGNOSIA: failure to recognize the manifestations of one's disease. Body schema disorders are usually noted when the non-dominant hemisphere is affected. With damage to the parietal lobe at the junction with the occipital and temporal lobes, disorders of higher brain functions can be combined. For example, switching off the posterior part of the left angular gyrus is accompanied by a triad of symptoms: digital agnosia, acalculia, and a violation of the right-left orientation - Gerstmann's syndrome. Irritation of the parietal lobe posterior to the postcentral gyrus causes paresthesia on the entire opposite half of the body - sensory Jacksonian seizures ..

Posterior central gyrus(cortical disorders of sensitivity by monotype, a- and hypoesthesia, sensitive hemiataxia?, with irritation - sensory jackson)

Superior parietal lobule– center of stereognosis; True astereognosis. With damage to the middle part of the postcentral gyrus - false; hemihypesthesia on the opposite side (with irritation - hemisensory seizures without a local onset, often with secondary generalization)

lower parietal lobule ( supramarginal - the center of praxis and angular - the center of reading)

Apraxia (for the dominant hemisphere, bilateral - ideational, constructive)

Alexia, acalculia, see Gerstmann = digital agnosia, acalculia and right-left disorientation

Violation of the scheme of the body (autotopagnosia, anosognosia, pseudopolymelia, pseudopolymelia; for the non-dominant hemisphere)

Lower quadrant hemianopsia (deep sections)

Similar information.

Handbook of a speech therapist Author unknown - Medicine

temporal lobe damage

The presence of pathological foci in the left temporal lobe (in right-handers) leads to severe disorders. When a lesion is localized in Wernicke's area, for example, sensory aphasia occurs, which leads to a loss of the ability to perceive speech. Sounds, individual words and whole sentences are not attached to the patient's concepts and objects known to him, which makes it almost impossible to establish contact with him. In parallel, the speech function of the patient himself is also impaired. Patients with a lesion localized in Wernicke's area retain the ability to speak; moreover, they even have excessive talkativeness, but their speech becomes incorrect. This is expressed in the fact that words that are necessary in meaning are replaced by others; the same applies to syllables and individual letters. In the most severe cases, the patient's speech is completely incomprehensible. The reason for this complex of speech disorders is that control over one's own speech falls out. A patient suffering from sensory aphasia loses the ability to understand not only someone else's speech, but also his own. As a result, paraphasia occurs - the presence of errors and inaccuracies in speech. If patients suffering from motor aphasia are more annoyed by their own speech errors, then people with sensory aphasia are offended by those who cannot understand their incoherent speech. In addition, with the defeat of Wernicke's area, there are disorders in reading and writing skills.

The rationale for an isolated speech disorder is as follows: a certain field is formed, localized between the cortical centers of hearing and vision (B.K. Sepp), which is the center of the combination of visual and auditory stimuli in a child. When the child begins to understand the meaning of words, they are compared in his mind with the visual image of the object that is simultaneously shown to him. Subsequently, the names of objects are deposited in the above combination field while improving the speech function. Thus, when this field, which is, in fact, associative paths between the fields of visual and auditory gnosia, is damaged, the connection between the object and its definition is destroyed.

Methods for the study of aphasia:

1) checking the understanding of speech addressed to the subject by suggesting the execution of the simplest commands - violations of the sensory function of speech are revealed; deviations can be caused both by damage to Wernicke's area and by apraxic disorders;

2) the study of the speech of the patient himself - attention is paid to the correctness and volume of the vocabulary; while examining the motor function of speech;

3) studying the function of reading - the ability to perceive written speech is checked;

4) study of the patient's ability to write - the presence of a paragraph in him is revealed;

5) identification of the presence of amnestic aphasia in a patient (it is proposed to name various objects).

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