Lentiform fork sign in a uremic patient with a high anion gap metabolic acidosis with seizures: a case report from North West of Ireland

Abstract

Background Lentiform fork sign is a neuroradiological abnormality which is encountered in the clinical practice associated with uremic encephalopathy, dialysis disequilibrium syndrome and metabolic acidosis. Case presentation We describe here a case of this neuro-radiological abnormality which was encountered in a patient with uraemia and high anion gap metabolic acidosis who presented with generalised convulsion and later had some tremor in her hands. In our patient, there were few predisposing factors which might have possibly resulted in this abnormality chronic kidney disease, diabetes mellitus, and metabolic acidosis. Conclusion The Lentiform fork sign is a rare occurrence which can be related to a long list of toxic and metabolic causes but in conjunction with metabolic acidosis in chronic kidney disease patients, it can narrow down this list of alternate diagnosis.

Biotics (Pre-, Pro-, Post-) and Uremic Toxicity: Implications, Mechanisms, and Possible Therapies

“…When renal function is compromised, acidosis (increased acidity) may develop due to reduced acid excretion. Acidosis can lead to metabolic disturbances and further contribute to kidney injury [ 98 ].…”

Uremic encephalopathy: A definite diagnosis by magnetic resonance imaging?

“…[9][10][11] Moreover, the presence of lentiform fork sign (LFS) has recently been used as an important neurological sign for the diagnosis of uremic encephalopathy, though it has been more limited to case studies. [12][13][14][15] All of these criteria can help the physician diagnose UE in the shortest time possible; but can imaging findings alone help diagnose uremic encephalopathy at early stage? Or which of these diagnostic methods (lab blood results, imaging, and clinical examination) is preferred to another?…”