Case Of the Week (COW) 21 April 2013
Answer:
CHRONIC KERNICTERUS
Findings:
Bilateral symmetric T2/FLAIR hyperintensities are seen in both Globus Pallidi.
Discussion:
Kernicterus is now a rare disorder Kernicterus is a neurological condition in the neonates characterized by cerebral deposition of unconjugated bilirubin. Also known as bilirubin encephalopathy, it is a rare complication of infantile hyperbilirubinemia which results from preferential deposition of bilirubin in the globus pallidus, subthalamic nuclei, hippocampus, putamen, thalamus, and cranial nerve nuclei (especially III, IV, and VI) In subacute and chronic stages of the disease,bilateral hyperintense lesions of the globus pallidus onT2-weighted images were seen as the most common finding . Pallidal injury, if partial, affects the medial posterior and inferior area of the nucleus. In addition, hyperintensities may alsobe seen in the thalami and subthalamic nuclei on T2-weighted images. In the acute phase of kernicterus (neonatal period),the most common finding is hyperintesities involving the bilateralglobus pallidus on T1-weighted images, with no appreciable signal alteration on the T2-weighted images. Similar changes can also be seen in the subthalamic nuclei In conclusion, our case show that in the proper clinical setting, kernicterus should be at the top of the list of differential diagnoses in patients with bilateral lesions of the globus pallidus on T2-weighted sequences.
Contributed By:
Dr. Aditya, Dr. Babu Peter, Dr. Sundareswaran
Barnard Institute of Radiology, Chennai
Answer:
CHRONIC KERNICTERUS
Findings:
Bilateral symmetric T2/FLAIR hyperintensities are seen in both Globus Pallidi.
Discussion:
Kernicterus is now a rare disorder Kernicterus is a neurological condition in the neonates characterized by cerebral deposition of unconjugated bilirubin. Also known as bilirubin encephalopathy, it is a rare complication of infantile hyperbilirubinemia which results from preferential deposition of bilirubin in the globus pallidus, subthalamic nuclei, hippocampus, putamen, thalamus, and cranial nerve nuclei (especially III, IV, and VI) In subacute and chronic stages of the disease,bilateral hyperintense lesions of the globus pallidus onT2-weighted images were seen as the most common finding . Pallidal injury, if partial, affects the medial posterior and inferior area of the nucleus. In addition, hyperintensities may alsobe seen in the thalami and subthalamic nuclei on T2-weighted images. In the acute phase of kernicterus (neonatal period),the most common finding is hyperintesities involving the bilateralglobus pallidus on T1-weighted images, with no appreciable signal alteration on the T2-weighted images. Similar changes can also be seen in the subthalamic nuclei In conclusion, our case show that in the proper clinical setting, kernicterus should be at the top of the list of differential diagnoses in patients with bilateral lesions of the globus pallidus on T2-weighted sequences.
Contributed By:
Dr. Aditya, Dr. Babu Peter, Dr. Sundareswaran
Barnard Institute of Radiology, Chennai