Max Jeffrey E, Fox Peter T, Lancaster Jack L, Kochunov Peter, Mathews Katherine, Manes Facundo F, Robertson Brigitte A M, Arndt Stephan, Robin Donald A, Lansing Amy E
University of California, San Diego and Children's Hospital and Health Center, USA.
J Am Acad Child Adolesc Psychiatry. 2002 May;41(5):563-71. doi: 10.1097/00004583-200205000-00014.
To investigate the association between focal stroke lesions of the putamen and either attention-deficit/hyperactivity disorder or traits of the disorder (ADHD/Traits).
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.
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).
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.
研究壳核局灶性中风病变与注意力缺陷多动障碍或该障碍的特质（ADHD/特质）之间的关联。
对25名患有局灶性中风病变的儿童进行了标准化的精神评估和脑部解剖磁共振成像研究。确定了患有ADHD/特质的受试者中病变重叠的模式。
25名受试者中有15名患有ADHD/特质。患有ADHD/特质的受试者中重叠病变最密集的区域（n = 7）包括腹侧壳核后部。病变体积中位数为9.7 cm³，分布高度偏态。病变体积与ADHD/特质无关。因此，以下分析集中在13名病变<10 cm³的受试者身上：7名有壳核病变的受试者中有6名表现出ADHD/特质，而6名无壳核病变的受试者中有2名表现出ADHD/特质（Fisher精确检验p = 0.1）。患有ADHD/特质的受试者中有一半（4/8）的重叠病变累及腹侧壳核后部。5名无ADHD/特质的受试者在这个根据经验得出的感兴趣区域均无病变（Fisher精确检验p = 0.1）。
富含多巴胺的腹侧壳核（腹侧或边缘纹状体的一部分）内的病变往往会增加患ADHD/特质的风险。因此，ADHD/特质可能是一种与该皮质-纹状体-丘脑-皮质环路功能障碍相关的去抑制综合征。
