Focal brain lactate accumulation in metformin-induced encephalopathy without systemic lactic acidosis: A case report suggesting mitochondrial vulnerability in lentiform fork sign

Metformin causes metabolic encephalopathy in some patients with end-stage chronic kidney disease, resulting in impaired consciousness and parkinsonism. This encephalopathy has a very characteristic magnetic resonance imaging feature in lentiform nuclei known as the “lentiform fork sign”. However, th...

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Autores principales:	Akira Hanazono, Yoshiko Takahashi, Yui Sanpei, Sachiko Kamada, Masashiro Sugawara
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2021
Materias:	Metformin-induced encephalopathy Lentiform fork sign Chronic kidney disease Lactate Diabetes Mitochondrial respiratory complex I Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/ed6278ae6dcb400d8536f17b6f9edd2c
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spelling	oai:doaj.org-article:ed6278ae6dcb400d8536f17b6f9edd2c2021-12-04T04:35:23ZFocal brain lactate accumulation in metformin-induced encephalopathy without systemic lactic acidosis: A case report suggesting mitochondrial vulnerability in lentiform fork sign2405-650210.1016/j.ensci.2021.100383https://doaj.org/article/ed6278ae6dcb400d8536f17b6f9edd2c2021-12-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2405650221000769https://doaj.org/toc/2405-6502Metformin causes metabolic encephalopathy in some patients with end-stage chronic kidney disease, resulting in impaired consciousness and parkinsonism. This encephalopathy has a very characteristic magnetic resonance imaging feature in lentiform nuclei known as the “lentiform fork sign”. However, the mechanism is unknown. Here, we report a case of metformin-induced encephalopathy with a novel observation of lactate accumulation in the lentiform nuclei on magnetic resonance spectroscopy without systemic lactic acidosis. Since metformin is an inhibitor of mitochondrial complex-I, this focal brain lactate accumulation implies that a part of the pathogenesis of metformin-induced encephalopathy is the focal vulnerability of mitochondria to metformin in the lentiform nuclei. When metformin causes encephalopathy, not only testing for serum lactic acidosis and performing routine magnetic resonance imaging but also evaluation of brain lactate accumulation by magnetic resonance spectroscopy should be required to elucidate the etiology.Akira HanazonoYoshiko TakahashiYui SanpeiSachiko KamadaMasashiro SugawaraElsevierarticleMetformin-induced encephalopathyLentiform fork signChronic kidney diseaseLactateDiabetesMitochondrial respiratory complex INeurology. Diseases of the nervous systemRC346-429ENeNeurologicalSci, Vol 25, Iss , Pp 100383- (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Metformin-induced encephalopathy Lentiform fork sign Chronic kidney disease Lactate Diabetes Mitochondrial respiratory complex I Neurology. Diseases of the nervous system RC346-429
spellingShingle	Metformin-induced encephalopathy Lentiform fork sign Chronic kidney disease Lactate Diabetes Mitochondrial respiratory complex I Neurology. Diseases of the nervous system RC346-429 Akira Hanazono Yoshiko Takahashi Yui Sanpei Sachiko Kamada Masashiro Sugawara Focal brain lactate accumulation in metformin-induced encephalopathy without systemic lactic acidosis: A case report suggesting mitochondrial vulnerability in lentiform fork sign
description	Metformin causes metabolic encephalopathy in some patients with end-stage chronic kidney disease, resulting in impaired consciousness and parkinsonism. This encephalopathy has a very characteristic magnetic resonance imaging feature in lentiform nuclei known as the “lentiform fork sign”. However, the mechanism is unknown. Here, we report a case of metformin-induced encephalopathy with a novel observation of lactate accumulation in the lentiform nuclei on magnetic resonance spectroscopy without systemic lactic acidosis. Since metformin is an inhibitor of mitochondrial complex-I, this focal brain lactate accumulation implies that a part of the pathogenesis of metformin-induced encephalopathy is the focal vulnerability of mitochondria to metformin in the lentiform nuclei. When metformin causes encephalopathy, not only testing for serum lactic acidosis and performing routine magnetic resonance imaging but also evaluation of brain lactate accumulation by magnetic resonance spectroscopy should be required to elucidate the etiology.
format	article
author	Akira Hanazono Yoshiko Takahashi Yui Sanpei Sachiko Kamada Masashiro Sugawara
author_facet	Akira Hanazono Yoshiko Takahashi Yui Sanpei Sachiko Kamada Masashiro Sugawara
author_sort	Akira Hanazono
title	Focal brain lactate accumulation in metformin-induced encephalopathy without systemic lactic acidosis: A case report suggesting mitochondrial vulnerability in lentiform fork sign
title_short	Focal brain lactate accumulation in metformin-induced encephalopathy without systemic lactic acidosis: A case report suggesting mitochondrial vulnerability in lentiform fork sign
title_full	Focal brain lactate accumulation in metformin-induced encephalopathy without systemic lactic acidosis: A case report suggesting mitochondrial vulnerability in lentiform fork sign
title_fullStr	Focal brain lactate accumulation in metformin-induced encephalopathy without systemic lactic acidosis: A case report suggesting mitochondrial vulnerability in lentiform fork sign
title_full_unstemmed	Focal brain lactate accumulation in metformin-induced encephalopathy without systemic lactic acidosis: A case report suggesting mitochondrial vulnerability in lentiform fork sign
title_sort	focal brain lactate accumulation in metformin-induced encephalopathy without systemic lactic acidosis: a case report suggesting mitochondrial vulnerability in lentiform fork sign
publisher	Elsevier
publishDate	2021
url	https://doaj.org/article/ed6278ae6dcb400d8536f17b6f9edd2c
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Focal brain lactate accumulation in metformin-induced encephalopathy without systemic lactic acidosis: A case report suggesting mitochondrial vulnerability in lentiform fork sign

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