Detection and explanation of sentence ambiguity are unaffected by hippocampal lesions but are impaired by larger temporal lobe lesions.

We address the recent suggestion that the "hippocampal system" is important for understanding ambiguities in language (MacKay et al., J Cogn Neurosci 1998;10:377-394). Seven amnesic patients and 11 controls first decided whether a sentence was ambiguous and then tried to explain the ambiguity. Three amnesic patients with damage limited to the hippocampal formation and one amnesic patient with primarily diencephalic damage performed like the controls in all respects. Thus, the ability to comprehend ambiguity is independent of the hippocampal formation. By contrast, three patients with larger temporal lobe lesions, which extended beyond the medial temporal lobe, were impaired to about the same degree as the noted amnesic patient H.M. (as reported by Lackner, Neuropsychologia 1974;12:199-207; MacKay et al., J Cogn Neurosci 1998;10:377-394). Patient H.M., like our 3 impaired patients, has some damage outside the medial temporal lobe. However, patient H.M. also had additional difficulties on these and other language tests that the patients with larger temporal lobe lesions did not exhibit. Accordingly, it is possible that H.M.'s impairment has a different basis.