A 5-day-old term neonate with untreated severe indirect hyperbilirubinaemia becomes increasingly lethargic, feeds poorly, and develops a high pitched cry with retrocollis and intermittent hypertonia. Which structure bears the maximal burden of bilirubin deposition responsible for these findings?

• A Cerebellar vermis and Purkinje cells
• B Spinal anterior horn cells
• C Frontal cortical neurons
• D Basal ganglia globus pallidus and subthalamic nuclei ✓

Explanation

Acute bilirubin encephalopathy preferentially stains the globus pallidus, subthalamic nuclei, hippocampus, and brainstem nuclei such as the oculomotor and vestibular nuclei. Early signs are lethargy, poor feeding, and a high pitched cry, progressing to retrocollis, opisthotonus, and fever. The chronic sequel is extrapyramidal choreoathetoid cerebral palsy with deafness and gaze palsy. Cortical involvement is characteristically absent, which explains preserved intellect in many survivors of kernicterus.

Reference: Nelson Textbook of Pediatrics, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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