Affiliations: Division of Cognitive Neurology, Department of
Neurology, University of South Florida and VA James A Haley Hospital, Tampa, FL
33612, USA. Tel.: +1 813 2598577; Fax: +1 813 2598551; E-mail:
mhoffman@health.usf.edu
Abstract: Background: Right temporal lobe lesion syndrome elicitation presents
a clinical challenge. Aside from occasional covert quadrantanopias, heralding
elementary neurological deficits are absent. Aim: Isolated right and left temporal lobe stroke patients
were analyzed for the panoply of known temporal and frontal cognitive and
neuropsychiatric syndromes. Methods: Temporal lobe stroke patients were analyzed, derived
from a dedicated cognitive stroke registry. Patients were screened by a
validated bedside cognitive battery and a neuropsychological test battery,
including the Bear Fedio Inventory for diagnosis of the Geschwind Gastaut (GG)
syndrome, frontal network syndrome testing (FNS), emotional intelligence
testing and delusional misidentification syndromes (DMIS). NIH stroke scores
were documented and lesion location identified with the 3 dimensional digitized
Cerefy coxial brain atlas. Exclusions were coma, encephalopathy and medication
related effects. Results: Of 2389 patients analyzed, in patients with isolated
right temporal lobe (IRT) stroke (n = 5, infarcts n = 3, hemorrhage n = 2),
the GG syndrome and FNS were present in all five. Other relatively frequent
syndromes included DMIS in 4, visuospatial dysfunction in 2 and amusia in 2. No
patient had a NIHSS greater than 1. The only elementary neurological sign was
quadrantanopia in 3 patients. Lesion location was mid and lateral temporal lobe
(n = 2), middle and mesial temporal lobe (n = 1) middle temporal lobe (n =
1) and lateral temporal lobe (n = 1). Comparison with isolated left temporal
lobe (ILT) stroke revealed syndromes of aphasia (n = 4), alexia (n = 2),
acalculia (n = 2), agnosia (n = 2), verbal amnesia (n = 1), none of which
occurred in the IRT patients. The mean NIHSS scores of IRT (0.6) and ILT
strokes (4.2) was different (t = 2.23, p = 0.04). The 2 × 8 Fisher
Exact Test revealed significant differences for the clusters of syndromes
occurring in the right and left isolated temporal lobe lesions (p =
0.00002). Conclusion: The GG syndrome, FNS and DMIS are prominent
syndrome constellations in stroke patients involving the right temporal lobe
and constitute the neurological deficit without heralding long tract signs. By
extrapolation these syndromes may also be present in the general right
hemisphere lesion population.
