Researchers at Children's Hospital of Michigan, Detroit report a boy aged 12 years with a 12-month history of ADHD, OCD, and stimulant-induced tourette syndrome that resolved following surgical removal of a right temporal lobe and basal ganglia oligodendroglioma. He had also developed complex partial seizures and two episodes of secondary generalized tonic clonic seizures. Oxcarbazepine controlled the seizures, and atomoxetine for ADHD was gradually withdrawn after surgery with no relapse of behavior. Radiation therapy was used for the residual tumor that increased in size 2 years after lesionectomy. Neuropsychological testing 3.5 years after surgery indicated normal verbal intellectual, memory, receptive language, and achievement, with impaired nonverbal, naming, and manual dexterity. Attentional, OCD, and anxiety symptoms resolved postoperatively. [1]

COMMENT. The authors recommend that children who present with ADHD, OCD, or tic disorder of late onset and in the absence of a family history should be investigated with brain MRI. This report emphasizes the importance of a neurological basis for ADHD and tics, and the need to exclude structural lesions in the cerebrum and connections with the basal ganglia. Children with ADHD of a genetic origin alone develop symptoms early, before 7 years of age. Other structural lesions sometimes associated with ADHD include temporal lobe arachnoid cyst [2], decreased size of splenium of corpus callosum [3], and decreased volume of prefrontal cortex, caudate nucleus, and globus pallidum. [4]

Two children who presented with chorea, athetosis and dystonia were diagnosed with astrocytoma of the thalamus and a pontine midbrain tumor [5]. Diagnoses of rheumatic chorea, dystonia musculorum deformans, and encephalitis were, entertained before fractional pneumoencephalography defined an expanding lesion. Of 300 intracranial tumors in children treated at the Mayo Clinic between 1950 and 1960, 4 percent involved the basal ganglia, but less than 1 per cent were associated with involuntary movements. A review of the literature found only 9 similar cases between 1923 and 1961.