Temporal Lobe Lesion

Temporal Lobe Lesion
SYMPTOMS Headaches, Auditory hallucinations, Language difficulties, Memory difficulties
Left sided homonymous hemianopia: Difficulty finding the next line
Right sided homonymous hemianopia: Difficulty seeing next letter or word
SIGNS Normal fundus with normal appearing optic nerves in both eyes
WORK-UP Pupils (typically normal) | EOMs (typically FROM) | Cover test | Color vision (Dyschromatopsia may be present) | Complete eye exam with dilation | Cranial nerve testing | Ptosis testing | OCT of the optic nerve | OCT of the macula (Ganglion cell loss that correlates with visual field loss) | VEP
Visual field threshold 30-2 (Homonymous hemianopia that is most dense superiorly or a superior homonymous quadrantanopia. Lesion is on side opposite the homonymous hemianopia or quadrantanopia)
TREATMENT Refer to neuro-ophthalmologist/neurology for further evaluation and treatment
After treatment, most visual recovery is noted in 1-4 months. Visual recovery after 6 months is unlikely. If visual symptoms are still present, patient should undergo vision rehabilitation and vision restorative training (glasses, prism, tint, etc)
FOLLOW-UP Patient will likely be monitored by neurology/neuro-ophthalmology on a regular basis. Patient should be evaluated once underlying neurological etiology is in control or stable.
Monitor every 3 months for the first year and then every 6-12 months
ADDITIONAL LAB | TESTS MRI with and without contrast of the brain (concentration on the temporal lobe)
Neurological evaluation
ETIOLOGY Temporal lesions are typically due to tumors
DIFFERENTIAL DX Parietal lobe lesion, Optic chiasm lesion, Occipital lobe lesion
NOTES “PITS” Parietal lobe lesion | Inferior visual field defect | Temporal lobe lesion | Superior visual field defect.