Neuroradiology Department, Centro Hospitalar de Lisboa Central, Lisboa, Portugal.
AJNR, Case of the week: Online publication, 3rd December 2015
Background: Kernicterus is a neurological manifestation of hyperbilirubinemia in the newborn, with premature neonates being more susceptible. It results from cerebral deposition of unconjugated bilirubin - globus pallidus (GP), subthalamic nucleus, hippocampus, putamen, cerebellar nuclei and thalamus
Relevant clinical information: Newborn (2-5 days-old) with jaundice, lethargy, hypotonia and high-pitched cry. Serum bilirubin levels >20mg/dL. Our patient had bilirubinemia of 46mg/dL.
Key diagnostic features: Imaging may be normal. Acute phase: increased SI on T1WI in GP and subthalamic nuclei. Symmetrical T2 high SI of GP (most common), subthalamic nuclei and hippocampus; less frequently: thalamus, striatum, substantial nigra, cerebellar nuclei and cranial nerves. Cerebral cortex and white matter are classically spared. T2 signal changes are more characteristic of the subacute and chronic phases.
Differential diagnosis: Hypoxic-Ischemic injury, inborn errors of metabolism, manganese deposition (total parental nutrition).
Treatment options: Phototherapy and exchange transfusion in severe cases