title: Putamen lesions and the development of attention-deficit/hyperactivity symptomatology.
abstract: 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.
authors.affiliation: University of California, San Diego and Children's Hospital and Health Center, USA. jmax@ucsd.edu
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Max
authors.forename: Peter T
authors.initials: PT
authors.lastname: Fox
authors.forename: Jack L
authors.initials: JL
authors.lastname: Lancaster
authors.forename: Peter
authors.initials: P
authors.lastname: Kochunov
authors.forename: Katherine
authors.initials: K
authors.lastname: Mathews
authors.forename: Facundo F
authors.initials: FF
authors.lastname: Manes
authors.forename: Brigitte A M
authors.initials: BA
authors.lastname: Robertson
authors.forename: Stephan
authors.initials: S
authors.lastname: Arndt
authors.forename: Donald A
authors.initials: DA
authors.lastname: Robin
authors.forename: Amy E
authors.initials: AE
authors.lastname: Lansing
mesh_terms: 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*