Lentiform fork sign in a uremic patient after inadvertent exposure to metformin.
Yen-An ChangDer-Cherng TarngChih-Yu YangPublished in: Clinical toxicology (Philadelphia, Pa.) (2021)
This case report describes a 56-year-old woman receiving regular hemodialysis for three years who presented with an unsteady gait for one month, dysarthria, and frequent choking on liquids for two weeks. Brain MRI revealed a characteristic "lentiform fork sign" with hyperintense T2W/FLAIR signal in the bilateral lentiform nuclei and restricted diffusion in bilateral globus pallidus. She was inadvertently prescribed metformin 1,000 mg per day one month ago by a physician who was unaware of her end-stage kidney disease. After intensive hemodialysis therapy with eight hemodialysis sessions within 12 days, her neurological deficits fully resolved. Clinicians should be aware of metformin-induced encephalopathy, presenting with relevant medication history, neurological symptoms, and the lentiform fork sign.
Keyphrases
- case report
- end stage renal disease
- peritoneal dialysis
- chronic kidney disease
- deep brain stimulation
- cerebral ischemia
- emergency department
- traumatic brain injury
- magnetic resonance imaging
- healthcare
- drug induced
- high glucose
- stem cells
- single cell
- diabetic rats
- computed tomography
- sleep quality
- oxidative stress
- diffusion weighted imaging
- bone marrow
- cell therapy
- smoking cessation
- electronic health record