An autopsy of an infant who died of kernicterus shows characteristic yellow staining of specific regions of the brain. Which structure is classically and most severely involved?

• A Globus pallidus of the basal ganglia ✓
• B Substantia nigra
• C Thalamic reticular nucleus
• D Frontal cortex layer III

Explanation

Unconjugated bilirubin deposited in lipid rich grey matter stains the globus pallidus, subthalamic nuclei, hippocampus, cerebellar vermis, and cranial nerve nuclei, with the globus pallidus being the classic site. The cerebral cortex and thalamus are characteristically spared, which explains the extrapyramidal choreoathetosis, deafness, and gaze palsy seen in survivors. Substantia nigra involvement is typical of Parkinson disease, not neonatal bilirubin toxicity.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.