Lentiform fork sign in a case of end-stage renal disease

Rathi, Manish; Mudrabettu, Chetan

doi:10.1038/ki.2012.119

Cited by 5 publications

(6 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Lentiform fork sign was recently described as a unique radiologic sign in patients with renal failure and UE with metabolic acidosis. A similar lesion has also been described in patients with normal renal function who had metabolic acidosis secondary to various other causes, suggesting that metabolic acidosis is an essential element in pathogenesis 11 …”

Section: Discussionsupporting

confidence: 58%

“…A similar lesion has also been described in patients with normal renal function who had metabolic acidosis secondary to various other causes, suggesting that metabolic acidosis is an essential element in pathogenesis. 11 Vasogenic edema of the lentiform nuclei is the underlying cause of this condition. It has been documented in cases of uremic encephalopathy, as well as in patients affected by methanol and ethylene glycol toxicity, propionic acidemia, pyruvate dehydrogenase deficiency, and mitochondrial disorders.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Uremic encephalopathy manifesting with a unique MRI finding (the lentiform fork sign) in an adult male: A case report

Alhusseini,

Hamsho,

Alabdullah

et al. 2023

Clinical Case Reports

View full text Add to dashboard Cite

Key Clinical MessageA novel radiologic sign in patients with renal failure and uremic encephalopathy (UE) with metabolic acidosis has recently been identified as the lentiform fork sign. On magnetic resonance imaging (MRI), the “lentiform fork sign” has been described as bilateral symmetrical hyperintensities in the basal ganglia encircled by a hyperintese rim delineating the lentiform nucleus. Changes in uremic solute retention, aberrant blood–brain barrier transport, disordered vascular reactivity, altered electrolyte and acid–base balance, and altered hormone metabolism are the most likely causes of the condition. A 56‐year‐old male with end‐stage renal disease was brought to the emergency room for a progressive change in mental status and involuntary arm movements over the previous 5 days, which were accompanied by mild dyspnea. A brain MRI was performed, and it revealed hyperintensity on T2/FLAIR in the white matter surrounding the basal ganglia. the patient was treated with dialysis and improved greatly. Intensified hemodialysis and glycemic control are the cornerstones of treating diabetic uremic syndrome (DUS) with likely reversible clinical symptoms and remission of imaging abnormalities.

show abstract

Section: Discussionsupporting

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Uremic encephalopathy manifesting with a unique MRI finding (the lentiform fork sign) in an adult male: A case report

Alhusseini,

Hamsho,

Alabdullah

et al. 2023

Clinical Case Reports

View full text Add to dashboard Cite

show abstract

“…Rathi and Mudrabettu[9] published a case report from India in nondiabetic ESRD patient with severe deranged renal function and metabolic acidosis, whose MRI brain showed Lentiform fork sign, but the patient succumbed. In our knowledge, this is the only case from India in diabetic ESRD on metformin presenting with this sign.…”

Section: Discussionmentioning

confidence: 99%

Metformin-associated encephalopathy in hemodialysis

Simon¹,

Thomas²

2019

Indian J Nephrol

View full text Add to dashboard Cite

Metformin-associated encephalopathy in maintenance hemodialysis is very rare in literature, till now only three to four cases are published. We report a patient on maintenance hemodialysis from standalone unit presented to us with abnormal neurological signs and symptoms. His medication chart included metformin, which he was taking for quite a long time. Computed tomography brain showed hypointensity in bilateral basal ganglia. Magnetic resonance imaging (MRI) brain showed hyperintensity in T2/fluid-attenuated inversion recovery sequences suggestive of Lentiform fork sign. We stopped metformin, and he was continued on regular hemodialysis. He showed dramatic improvement in neurological manifestations. Two months later, we repeated MRI brain, which showed resolution of basal ganglia changes. We should suspect the possibility of this when a diabetic end-stage renal disease presents with unknown etiology of encephalopathy.

show abstract

“…In cases with uremia, this finding has been reported in patients either not on dialysis or on irregular dialysis and in a child with dialysis disequilibrium during the first dialysis session. [ 4 5 6 ] However, in our patient, the clinical and radiological findings appeared late that is after several sessions of hemodialysis. Also, at the point of onset of signs and symptoms there was no significant metabolic acidosis.…”

mentioning

confidence: 55%

“…[ 1 ] This sign has been described in clinical situations with metabolic acidosis including poisonings and uremia. [ 2 3 4 5 ] and in a child with dialysis disequilibrium syndrome. [ 6 ] Delayed appearance of this MRI sign after several weeks of dialysis has not been reported so far.…”

mentioning

confidence: 99%