Albadr Fahad, Alqadeeb Abdulmohsen S, Alzaid Walid S, Alalwan Faisal A, Alomar Yazeed A, Alomar Muhannad A, Bafarat Abdullah M
Radiology and Medical Imaging/Neuroradiology, King Saud University Medical City, Riyadh, SAU.
College of Medicine, King Saud University, Riyadh, SAU.
Cureus. 2024 Nov 24;16(11):e74339. doi: 10.7759/cureus.74339. eCollection 2024 Nov.
Uremic encephalopathy (UE) is a neurological complication of renal failure characterized by cognitive dysfunction and movement abnormalities. A novel radiologic sign termed the "lentiform fork sign" has been identified in patients with UE and metabolic acidosis. This sign manifests as bilateral symmetrical hyperintensities in the basal ganglia, bordered by a hyperintense rim on magnetic resonance imaging (MRI), particularly on T2-weighted and fluid-attenuated inversion recovery (FLAIR) sequences. The basal ganglia, highly metabolically active structures, are prone to damage from metabolic derangements, toxins, and systemic conditions. We present a 56-year-old male with a history of chronic kidney disease and diabetes mellitus, maintained on hemodialysis and metformin. The patient presented with acute neurological symptoms, including slurred speech, left-sided weakness, and dysarthria. Brain MRI revealed bilateral basal ganglia hyperintensities on T2-weighted images, consistent with the lentiform fork sign. Laboratory investigations showed elevated serum urea and metabolic acidosis, suggestive of uremic encephalopathy. The patient's condition improved following dialysis, leading to partial resolution of neurological symptoms.
尿毒症性脑病（UE）是肾衰竭的一种神经并发症，其特征为认知功能障碍和运动异常。在患有UE和代谢性酸中毒的患者中发现了一种名为“豆状核叉征”的新型放射学征象。该征象在磁共振成像（MRI）上表现为基底节区双侧对称性高信号，在T2加权像和液体衰减反转恢复（FLAIR）序列上尤其可见其边界有一条高信号边缘。基底节区是代谢高度活跃的结构，容易受到代谢紊乱、毒素和全身状况的损害。我们报告一名56岁男性，有慢性肾脏病和糖尿病病史，维持血液透析并服用二甲双胍。该患者出现急性神经症状，包括言语含糊、左侧肢体无力和构音障碍。脑部MRI在T2加权像上显示双侧基底节区高信号，符合豆状核叉征。实验室检查显示血清尿素升高和代谢性酸中毒，提示尿毒症性脑病。透析后患者病情改善，神经症状部分缓解。
