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

• Published in: Clinical case reports Vol. 11; no. 11; pp. e8233 - n/a
• Main Authors: Alhusseini, Ayham, Hamsho, Suaad, Alabdullah, Hadi, Alaswad, Mohammed, Sleiay, Mouhammed, Alsamarrai, Omar
• Format: Journal Article
• Language: English
• Published: England John Wiley & Sons, Inc 01-11-2023; Wiley
• Subjects: Acidosis; Antipsychotics; Blood pressure; Case reports; Consciousness; Dehydrogenases; Diabetes; diabetic uremic syndrome; Edema; Emergency medical care; Hemodialysis; Kidney diseases; Laboratories; lentiform fork; Magnetic resonance imaging; Metabolism; Movement disorders; Neurotoxicity; Pathogenesis; Patients; Psychotropic drugs; Tremor (Muscular contraction); uremia; uremic encephalopathy; Vitamin B; Vitamin deficiency; uremia; uremic encephalopathy; lentiform fork; diabetic uremic syndrome
• ISSN: 2050-0904; 2050-0904
• DOI: 10.1002/ccr3.8233

Key Clinical Message
A 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.
A hyperintensity on T2/FLAIR in the basal ganglia.