Putamen lesions and the development of attention-deficit/hyperactivity symptomatology.
OBJECTIVE
To investigate the association between focal stroke lesions of the putamen and either attention-deficit/hyperactivity disorder or traits of the disorder (ADHD/Traits).


METHODS
Twenty-five children with focal stroke lesions were studied with standardized psychiatric assessments and anatomic brain magnetic resonance imaging. The pattern of lesion overlap in subjects with ADHD/Traits was determined.


RESULTS
Fifteen of 25 subjects had ADHD/Traits. The densest area of overlapping lesions (n = 7) in subjects with ADHD/Traits included the posterior ventral putamen. The median lesion volume was 9.7 cm3, and the distribution was highly skewed. Lesion volume was not associated with ADHD/Traits. Therefore the following analyses focused on the 13 subjects with lesions < 10 cm3: ADHD/Traits were exhibited in 6/7 subjects with putamen lesionsversus 2/6 with no putamen lesions (Fisherexacttestp= .1). Half (4/8) of the subjects with ADHD/Traits had overlapping lesions encompassing the posterior ventral putamen. None of the 5 subjects without ADHD/Traits had lesions in this empirically derived region of interest (Fisher exact test p = .1).


CONCLUSIONS
Lesions within the dopamine-rich ventral putamen, which is part of the ventral or limbic striatum, tended to increase the risk of ADHD/Traits. ADHD/Traits may therefore be a disinhibition syndrome associated with dysfunction in this cortical-striato-thalamocortical loop.
Max
Jeffrey E
JE
University of California, San Diego and Children's Hospital and Health Center, USA. jmax@ucsd.edu
Fox
Peter T
PT
Lancaster
Jack L
JL
Kochunov
Peter
P
Mathews
Katherine
K
Manes
Facundo F
FF
Robertson
Brigitte A M
BA
Arndt
Stephan
S
Robin
Donald A
DA
Lansing
Amy E
AE
D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis / Q000503:physiopathology*; D020144:Basal Ganglia Cerebrovascular Disease / Q000175:diagnosis / Q000503:physiopathology*; D001925:Brain Damage, Chronic / Q000175:diagnosis / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D011699:Putamen / Q000473:pathology / Q000503:physiopathology*; D020521:Stroke / Q000175:diagnosis / Q000503:physiopathology*