Case Report: A Case of Encephalopathy Presenting the Lentiform Fork Sign on MRI in a Diabetic Dialysis Patient [version 2; peer review: 2 approved]

Basal ganglia lesions showing an expansile high signal intensity on T2-weighted MRI are termed the lentiform fork sign. This specific finding is mainly observed in diabetic patients with uremic encephalopathy with metabolic acidosis, although there are also reports in patients with ketoacidosis, dia...

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Autores principales:	Yuri Ishizaki, Ryuzoh Nishizono, Masao Kikuchi, Hiroko Inagaki, Yuji Sato, Shouichi Fujimoto
Formato:	article
Lenguaje:	EN
Publicado:	F1000 Research Ltd 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/36cfbb6c2db848cba61c6f6a3a27d5b4
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spelling	oai:doaj.org-article:36cfbb6c2db848cba61c6f6a3a27d5b42021-11-22T12:41:06ZCase Report: A Case of Encephalopathy Presenting the Lentiform Fork Sign on MRI in a Diabetic Dialysis Patient [version 2; peer review: 2 approved]2046-140210.12688/f1000research.25597.2https://doaj.org/article/36cfbb6c2db848cba61c6f6a3a27d5b42021-10-01T00:00:00Zhttps://f1000research.com/articles/9-969/v2https://doaj.org/toc/2046-1402Basal ganglia lesions showing an expansile high signal intensity on T2-weighted MRI are termed the lentiform fork sign. This specific finding is mainly observed in diabetic patients with uremic encephalopathy with metabolic acidosis, although there are also reports in patients with ketoacidosis, dialysis disequilibrium syndrome, intoxication, and following drug treatment (e.g., metformin). A 57-year-old Japanese man on chronic hemodialysis for 4 years because of diabetic nephropathy was admitted to our hospital for relatively rapid-onset gait disturbance, severe dysarthria, and consciousness disturbance. Brain T2-weighted MRI showed the lentiform fork sign. Hemodialysis was performed the day before admission, and laboratory tests showed mild metabolic (lactic) acidosis, but no uremia. Surprisingly, metformin, which is contraindicated for patients with end-stage kidney disease, had been prescribed for 6 months in his medication record, and his sluggish speaking and dysarthria appeared gradually after metformin treatment was started. Thus, the encephalopathy was considered to be related to metformin treatment. He received hemodialysis treatment for 6 consecutive days, and his consciousness disturbance and dysarthria improved in 1 week. At the 8-month follow-up, the size of the hyperintensity area on MRI had decreased, while the mild gait disturbance remained. Considering the rapid onset of gait and consciousness disturbance immediately before admission, diabetic uremic syndrome may also have occurred with metformin-related encephalopathy, and resulted in the lentiform fork sign, despite the patient showing no evidence of severe uremia on laboratory data.Yuri IshizakiRyuzoh NishizonoMasao KikuchiHiroko InagakiYuji SatoShouichi FujimotoF1000 Research LtdarticleMedicineRScienceQENF1000Research, Vol 9 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Yuri Ishizaki Ryuzoh Nishizono Masao Kikuchi Hiroko Inagaki Yuji Sato Shouichi Fujimoto Case Report: A Case of Encephalopathy Presenting the Lentiform Fork Sign on MRI in a Diabetic Dialysis Patient [version 2; peer review: 2 approved]
description	Basal ganglia lesions showing an expansile high signal intensity on T2-weighted MRI are termed the lentiform fork sign. This specific finding is mainly observed in diabetic patients with uremic encephalopathy with metabolic acidosis, although there are also reports in patients with ketoacidosis, dialysis disequilibrium syndrome, intoxication, and following drug treatment (e.g., metformin). A 57-year-old Japanese man on chronic hemodialysis for 4 years because of diabetic nephropathy was admitted to our hospital for relatively rapid-onset gait disturbance, severe dysarthria, and consciousness disturbance. Brain T2-weighted MRI showed the lentiform fork sign. Hemodialysis was performed the day before admission, and laboratory tests showed mild metabolic (lactic) acidosis, but no uremia. Surprisingly, metformin, which is contraindicated for patients with end-stage kidney disease, had been prescribed for 6 months in his medication record, and his sluggish speaking and dysarthria appeared gradually after metformin treatment was started. Thus, the encephalopathy was considered to be related to metformin treatment. He received hemodialysis treatment for 6 consecutive days, and his consciousness disturbance and dysarthria improved in 1 week. At the 8-month follow-up, the size of the hyperintensity area on MRI had decreased, while the mild gait disturbance remained. Considering the rapid onset of gait and consciousness disturbance immediately before admission, diabetic uremic syndrome may also have occurred with metformin-related encephalopathy, and resulted in the lentiform fork sign, despite the patient showing no evidence of severe uremia on laboratory data.
format	article
author	Yuri Ishizaki Ryuzoh Nishizono Masao Kikuchi Hiroko Inagaki Yuji Sato Shouichi Fujimoto
author_facet	Yuri Ishizaki Ryuzoh Nishizono Masao Kikuchi Hiroko Inagaki Yuji Sato Shouichi Fujimoto
author_sort	Yuri Ishizaki
title	Case Report: A Case of Encephalopathy Presenting the Lentiform Fork Sign on MRI in a Diabetic Dialysis Patient [version 2; peer review: 2 approved]
title_short	Case Report: A Case of Encephalopathy Presenting the Lentiform Fork Sign on MRI in a Diabetic Dialysis Patient [version 2; peer review: 2 approved]
title_full	Case Report: A Case of Encephalopathy Presenting the Lentiform Fork Sign on MRI in a Diabetic Dialysis Patient [version 2; peer review: 2 approved]
title_fullStr	Case Report: A Case of Encephalopathy Presenting the Lentiform Fork Sign on MRI in a Diabetic Dialysis Patient [version 2; peer review: 2 approved]
title_full_unstemmed	Case Report: A Case of Encephalopathy Presenting the Lentiform Fork Sign on MRI in a Diabetic Dialysis Patient [version 2; peer review: 2 approved]
title_sort	case report: a case of encephalopathy presenting the lentiform fork sign on mri in a diabetic dialysis patient [version 2; peer review: 2 approved]
publisher	F1000 Research Ltd
publishDate	2021
url	https://doaj.org/article/36cfbb6c2db848cba61c6f6a3a27d5b4
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Case Report: A Case of Encephalopathy Presenting the Lentiform Fork Sign on MRI in a Diabetic Dialysis Patient [version 2; peer review: 2 approved]

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