The field defects produced by temporal lobe lesions / by Harvey Cushing.

  • Cushing, Harvey, 1869-1939.
Date:
1921
Catalogue details

Licence: In copyright

Credit: The field defects produced by temporal lobe lesions / by Harvey Cushing. Source: Wellcome Collection.

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    pictures cannot be at all uncommon, and whether they are related in any way to the olfactory and gustatory discharges of the typical uncinate fit or are merely associated with some pressure implication of the visual pathway or the geniculate body, I am at a loss to say. Certainly they bear some relation to the damaged geniculo-calcarine radiation, for in this series, whenever its situation has been mentioned, the hallucina¬ tion has always been referred by the patient to the side opposite that occupied by the lesion, in other words, in the defective fields. One of the most remarkable examples of these hallucinations of which I have record occurred in one of the patients in my Baltimore series. It was a young man under observation for a long period who had repeated uncinate attacks, many of which were observed and described in detail. They invariably had the same character and left a vivid and disagreeable recollection. As in a dream he saw, always to his left side, his father and some other men in an unfamiliar room engaged in a game of cards which ultimately led to an altercation. The scene would fade and leave him with a bad taste and smell of something indescribably horrid. Objectively, during the course of ordinary conversation, possibly while standing, a vague look would come over his face, he would turn his head and stare to the left and shortly after would begin to make smacking and tasting movements with his lips. This was followed by an expression of disgust and the attack would be over. He had an homonymous upper quadrantal defect produced by a temporal lobe glioma. One would naturally expect visual hallucinations to be a feature of occipital rather than of temporal lobe tumours, but the former are far less common in my series and, though they have not been thoroughly studied with this point in view, it is my impression that they are less prone to have petit mat attacks and that the subjective visual pheno¬ mena, if any, are more likely to be of colours and lights than of pictured scenes.1 1 Though I have not fully looked up the general subject of visual hallucinations in this connection, it appears to me that those who have observed these states in association with a homonymous hemianopsia have taken it for granted, without any real justification, that the lesion necessarily was in the occipital lobe. This certainly is true of the case reported by Paul Camus (L’Encephale, 1911, 6, Part I, 521-531) and also of some of the other cases in the literature to which he refers. In an earlier paper by Pick (Amer. J. M. Sc., 1904, 127> 82-92) there is a good example of what I would take to be a left temporal tumour which he localizes, however, in the angular gyrus. All that can be said of such case reports is that without a post-mortem examination or verification of the situation of the lesion at operation, judging from the cases in this series, one at least is not justified in ascribing too much to the occipital lobe.