A 2-day-old term neonate with untreated severe indirect hyperbilirubinemia becomes lethargic and refuses feeds, then develops a high pitched cry, retrocollis, arching of the trunk, and episodic fever. Which structure bears the maximum burden of bilirubin deposition responsible for these findings?

• A Cerebellar vermis and Purkinje cells
• B Globus pallidus and subthalamic nuclei ✓
• C Hippocampal pyramidal neurons
• D Motor cortex Betz cells

Explanation

Acute bilirubin encephalopathy progresses through early lethargy and poor feeding, intermediate high pitched cry, retrocollis, opisthotonus and fever, and finally advanced stupor and seizures. Unbound bilirubin deposits preferentially in the globus pallidus, subthalamic nuclei and hippocampus, with the basal ganglia involvement explaining the dystonic posture. Survivors develop chronic kernicterus with athetoid cerebral palsy and sensorineural deafness.

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.