Magnetic Resonance Imaging Findings in Patients With Severe Neonatal Indirect Hyperbilirubinemia

Abstract

The aim of this study was to document the magnetic resonance imaging (MRI) findings of cases with a history of severe neonatal indirect hyperbilirubinemia. Ten cases (eight cases with neurologic findings, two normal cases) with a history of severe neonatal indirect hyperbilirubinemia were studied. Neurologic findings and MRI results were described and correlated. Seven of eight cases with neurologic findings demonstrated symmetric and uniform increased T2 signal changes limited to globus pallidi. MRI scans of two cases without neurologic findings showed no abnormality. Severe neonatal indirect hyperbilirubinemia should be considered in the differential diagnosis of bilateral symmetric hyperintense signal changes in the globus pallidus on MRI. However, high levels of unconjugated bilirubin concentrations in the neonatal period may not always cause such lesions of globus pallidus on MRI despite the presence of neurologic findings.

Thalamic involvement in a patient with kernicterus

“…Maximum serum indirect bilirubin level of our patient was 35 mg/dl and the aetiology of jaundice was Rh isoimmunisation. Serum bilirubin levels of reported patients were between 17.7 and 50 mg/dl, and the aetiologies of jaundice were Rh and ABO incompatibility, G6PD deficiency and unknown causes [2,3,4,5,6,7,12]. There may be other factors, except for serum indirect bilirubin level and the aetiology of hyperbilirubinemia, that affect the neuroradiological findings of patients with kernicterus.…”

“…Bilateral symmetrical high signals in the globus pallidus on T2-weighted images are the most common reported findings [2,3,4,5,6,7]. Steinborn et al reported symmetrical signal intensity changes in the subthalamic nucleus in addition to the globus pallidus on T2-weighted images in a patient with kernicterus [12].…”

“…The most characteristic pattern of neuropathological lesions in kernicterus is symmetric and highly selective involvement of the basal ganglia [1,2]. It has been reported that patients with neurological deficits due to bilirubin toxicity may exhibit bilateral symmetric globus pallidus hyperintensities on T2-weighted MR scans [3,4,5,6,7,8]. We describe a case of kernicterus where MR imaging demonstrated bilateral symmetric hyperintensity in the thalamus in addition to globus pallidus on T2-weighted images.…”

Hyperintense globus pallidus on T1-weighted MR imaging in acute kernicterus: is it common or rare?

“…Although kernicterus affects various parts of the central nervous system, only the GP demonstrates remarkable signal changes with MR imaging [7]. The most commonly reported and characteristic MR imaging finding of kernicterus, after the acute period, is bilateral hyperintense GP lesions on T2-weighted MR images.…”

Neuroimaging in cerebral palsy

“…70 Bilirubin is a toxin that targets the globus pallidus, 71 rather than the putamen-thalamus, as in HIE. This is another example of the concept of selective vulnerability, and supports the importance of imaging to determine lesion location.…”