Objective: To investigate structural basal ganglia abnormalities in attention-deficit hyperactivity disorder (ADHD) and their relationship with the neuropsychological deficits and behavioral problems found in ADHD. Design: Case-control study. Setting: Adolescents were recruited from a local polytechnic institute of secondary education. Subjects: Eleven adolescents with ADHD and 19 healthy control subjects. Subjects with ADHD were diagnosed by the school psychologist from a total population of 450 students according to theDiagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised. Diagnosis was confirmed by the Conners Teachers Rating Scale and a structured family interview. Main Outcome Measures: Magnetic resonance imaging single-slice transversal measurements of the head of the caudate nucleus and a comprehensive neuropsychological evaluation, which was specially designed to assess frontal-striatal functioning. Results: The ADHD group had a larger right caudate nucleus area than the control group. In control adolescents, larger caudate nucleus areas were associated with poorer performance on tests of attention and higher ratings on the Conners Teachers Rating Scale. Conclusions: These findings provide further evidence of the involvement of the caudate nucleus in the neuropsychological deficits and behavioral problems found in ADHD. The larger caudate nucleus found in the ADHD group could be related to a failure of the maturational processes that normally result in volume reduction.
Aim: To analyse the influence of apolipoprotein (APOE) ε4 status on the cognitive and behavioural functions usually impaired after moderate and severe traumatic brain injury (TBI). Methods: In all, 77 patients with TBI selected from 140 consecutive admissions were genotyped for APOE. Each patient was subjected to neuropsychological and neurobehavioural assessment at least 6 months after injury. Results: Performance of participants carrying the ε4 allele was notably worse on verbal memory (Auditory Verbal Learning Test), motor speed, fine motor coordination, visual scanning, attention and mental flexibility (Grooved Pegboard, Symbol Digit Modalities Test and part B of the Trail Making Test) and showed considerably more neurobehavioural disturbances (Neurobehavioral Rating Scale—Revised) than the group without the ε4 allele. Conclusions: In particular, performance on neuropsychological tasks that are presumed to be related to temporal lobe, frontal lobe and white matter integrity is worse in patients with the APOE ε4 allele than in those without it. More neurobehavioural disturbances are observed in APOE ε4 carriers than in APOE ε2 and ε3 carriers.
The primary goal of this study was to determine the incidence of post-traumatic ventriculomegaly (Evans' index ≥ 0.30) in 95 head-injured patients with a Glasgow Coma Scale (GCS) score of ≤13 at admission. Additional objectives were to determine the relationship between an increase in ventricular size and several clinical and radiological features and outcome. A planimetric study was carried out in the sequential control computed tomography (CT) scans of 34 moderately head-injured (GCS 9–13) and 61 severely head-injured (GCS 3–8) patients with a minimum follow-up of 2 months. Between two and six CT scans were evaluated in each patient. The presence of subarachnoid hemorrhage (SAH) was registered. Evans' index was determined in all CT scans. In the final CT scan of each patient, ventricular size was related to the admission GCS score, age, the presence of SAH in the initial CT scans, type of brain lesion (classified according to the final diagnosis in the Traumatic Coma Data Bank classification), and outcome. Ventriculomegaly was found in 39.3% of patients with severe head injury and in 27.3% of those with a moderate head injury. Increased ventricular size was evident 4 weeks after injury in 57.6% and 2 months after injury in 69.7%. No relationship was found between post-traumatic ventriculomegaly and age, initial GCS score, the presence of SAH, or type of lesion (focal or diffuse). Post-traumatic ventriculomegaly was significantly correlated with outcome. Post-traumatic ventriculomegaly is a frequent and early finding in patients with moderate or severe traumatic brain injury.