Putamen Lesions and the Development of Attention-Deficit/Hyperactivity Symptomatology

Jeffrey E. Max; Peter T. Fox; Jack L. Lancaster; Peter Kochunov; Katherine Mathews; Facundo F. Manes; Brigitte A M Robertson; Stephan Arndt; Donald A. Robin; Amy E. Lansing

doi:10.1097/00004583-200205000-00014

Putamen Lesions and the Development of Attention-Deficit/Hyperactivity Symptomatology

Jeffrey E. Max^*, Peter T. Fox, Jack L. Lancaster, Peter Kochunov, Katherine Mathews, Facundo F. Manes, Brigitte A M Robertson, Stephan Arndt, Donald A. Robin, Amy E. Lansing

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

95 Citations (Scopus)

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). Method: 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 cm ³, 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 cm ³: ADHD/Traits were exhibited in 6/7 subjects with putamen lesions versus 2/6 with no putamen lesions (Fisher exact test p=.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.

Original language	English
Pages (from-to)	563-571
Number of pages	9
Journal	Journal of the American Academy of Child and Adolescent Psychiatry
Volume	41
Issue number	5
DOIs	https://doi.org/10.1097/00004583-200205000-00014
Publication status	Published - May 2002
Externally published	Yes

Keywords

Attention-deficit/hyperactivity disorder
Childhood stroke
Putamen

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10.1097/00004583-200205000-00014

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Max, J. E., Fox, P. T., Lancaster, J. L., Kochunov, P., Mathews, K., Manes, F. F., Robertson, B. A. M., Arndt, S., Robin, D. A., & Lansing, A. E. (2002). Putamen Lesions and the Development of Attention-Deficit/Hyperactivity Symptomatology. Journal of the American Academy of Child and Adolescent Psychiatry, 41(5), 563-571. https://doi.org/10.1097/00004583-200205000-00014

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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). Method: 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 cm 3, 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 cm 3: ADHD/Traits were exhibited in 6/7 subjects with putamen lesions versus 2/6 with no putamen lesions (Fisher exact test p=.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.",

keywords = "Attention-deficit/hyperactivity disorder, Childhood stroke, Putamen",

author = "Max, {Jeffrey E.} and Fox, {Peter T.} and Lancaster, {Jack L.} and Peter Kochunov and Katherine Mathews and Manes, {Facundo F.} and Robertson, {Brigitte A M} and Stephan Arndt and Robin, {Donald A.} and Lansing, {Amy E.}",

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AU - Manes, Facundo F.

AU - Robertson, Brigitte A M

AU - Arndt, Stephan

AU - Robin, Donald A.

AU - Lansing, Amy E.

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N2 - 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). Method: 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 cm 3, 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 cm 3: ADHD/Traits were exhibited in 6/7 subjects with putamen lesions versus 2/6 with no putamen lesions (Fisher exact test p=.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.

AB - 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). Method: 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 cm 3, 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 cm 3: ADHD/Traits were exhibited in 6/7 subjects with putamen lesions versus 2/6 with no putamen lesions (Fisher exact test p=.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.

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Putamen Lesions and the Development of Attention-Deficit/Hyperactivity Symptomatology

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