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Tibial Eminence Fracture
Joseph Junewick, MD FACR
over 5 years ago
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ARSt Case Repository

Kernicterus

Case Detail

Anatomy: Brain-Spine
Junewick
Joseph Junewick, MD FACR
Diagnostic Category: Metabolic
Created: over 8 years ago
Updated: over 8 years ago
Tags: PEDS
Modality/Study Types: MR
Activities:
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History

2 week old with jaundice.


Case Images


Diagnosis

Kernicterus

Findings

MR – Sagittal and axial T1 and axial GRE images demonstrate hyperintensity in the thalami and globus pallidi.

Discussion

Kernicterus is the result of toxic accumulation of free bilirubin in the brain. It may present with somnolence, hypotonia, opisthotonus, rigidity, and/or high pitched cry. Many of these symptoms overlap with sepsis, asphyxia, and hypoglycemia.

Bilirubin is usually bound by albumin and is nontoxic but free bilirubin is toxic. Bilirubin is symmetrically deposited in the pallidum, subthalamic nuclei and horn of Ammon and less often in the thalami, striatum and cranial nerve nuclei (III, IV and VI). Bilirubin inhibits astrocyte uptake of glutamine; increased glutamine in the synaptic spaces leads to overstimulation of neurons and neuronal death.

Kernicterus is manifest as high signal on MR, most pronounced on T1 and GRE. Glutamine and glutamate levels are increased and choline levels are decreased on MR spectroscopy. Differential diagnosis for the conventional MR abnormalities in this case would include hypoxia, hypoglycemia, carbon monoxide intoxication, and inborn errors of metabolism.

Reference

Matrich-Kriss V, Kollias SS, Ball WS. MR findings in kernicterus. AJNR (1995);16:819-821.

Oakden WK, et al. 1-H MR spectroscopic changes of kernicterus: A possible metabolic signature. AJNR (2005); 26:1571-1574.



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