Exploring the Spectrum of Bilirubin-Induced Brain Injury: A Case of Spastic Cerebral Palsy and Sensorineural Hearing Loss Post-Kernicterus

Advisor Doctor and Expert Trainer, Baghdad Medical City and Iraqi Ministry of Health Baghdad, Iraq

*Corresponding Author: Aamir Jalal Al-Mosawi, Advisor Doctor and Expert Trainer, Baghdad Medical City and Iraqi Ministry of Health Baghdad, Iraq, Email: [email protected]

Received Date: April 02, 2026

Published Date: May 22, 2026

Citation: Al-Mosawi AJ. (2026). Exploring the Spectrum of Bilirubin-Induced Brain Injury: A Case of Spastic Cerebral Palsy and Sensorineural Hearing Loss Post-Kernicterus. Mathews J Case Rep. 11(2):225.

Copyrights: Al-Mosawi AJ. © (2026).

ABSTRACT

Background: Kernicterus is a rare neurological condition caused by bilirubin toxicity, typically leading to dyskinetic or choreoathetoid cerebral palsy and sensorineural hearing loss. This condition usually involves injury to deep brain structures like the globus pallidus and subthalamic nuclei, but emerging reports suggest variability in clinical outcomes. This report describes an unusual case of spastic cerebral palsy and hearing loss following kernicterus, with MRI findings suggestive of both classic kernicterus and features more typical of spastic cerebral palsy. Patients and methods: A 6-year-old boy from South Africa developed severe hyperbilirubinemia (total serum bilirubin exceeding 30 mg/dL) shortly after birth, requiring exchange transfusion. Despite no history of perinatal asphyxia, the child developed acute bilirubin encephalopathy. When seen at the age of six, he had severe spasticity, impaired head control, and poor alertness, with no dystonic or choreoathetoid movements. MRI at 2 years showed basal ganglia involvement, periventricular white matter changes, corpus callosum thinning, and cerebral atrophy. Hearing assessment revealed severe bilateral sensorineural hearing loss. Results: The child received a multimodal neurorestorative therapy regimen, including cerebrolysin, piracetam, citicoline, baclofen, and nutritional support. Over the course of a month, notable improvements were observed: increased alertness, social responsiveness, improved head control, reduced spasticity, and the ability to chew solid food for the first time. Conclusion: This case demonstrates an atypical presentation of kernicterus with spastic cerebral palsy and sensorineural hearing loss, raising questions about the variability in bilirubin-induced brain injury. It also underscores the potential for significant functional recovery with multimodal neurorestorative therapy, even in severe cases.

Keywords: Kernicterus, Spastic Cerebral Palsy, Sensorineural Hearing Loss, Bilirubin Encephalopathy, Neurorestorative Therapy, Neuroplasticity.