Chronic Kernicterus: MRI

Child on MRI shows bilateral high signal on T2/FLAIR weighted images in globus pallidus & subthalamic nuclei.  Differentials include chronic kernicterus versus other metabolic causes of  symmetric globus pallidus hyperintensity. In kernicterus, only subthalamic nuclei are involved with sparing of thalami. This helps to differentiate this condition from ischemic and metabolic disorders.

The important differential diagnoses of acute cases are hypoxia, hypoglycemia, carbon monoxide poisoning, and encephalitis while of chronic cases are dysmyelinating disorders, inborn errors of metabolism, and various degenerative diseases. Hyperintense signals in the globus pallidus are nonspecific findings; however, along with proper clinical history, examination, and investigation they can establish the diagnosis of kernicterus.