Lentiform fork sign in a diabetic uremic patient: pathophysiology is still not clear

Özet

Neurological disorders observed in end stage renal disease (ESRD) other than clouding of consciousness, involuntary move-ments and uremic encephalopathy capable of causing seizures include wakefulness defect caused by effects on basal gan-glia associated with metabolic acidosis, movement disorder and, independent of these, progressive cognitive impairment of insidious onset. A 57-year-old male patient was started on hemodialysis (HD) with a diagnosis of ESRD secondary to diabetic nephropathy 5 months ago while under monitoring for diabetes mellitus and hypertension known for the previous 10 years. The patient presented to our hospital emergency service due to clouding of consciousness, wakefulness defect and lack of appetite that had begun 2 days ago. Computed tomography (CT) and diffusion magnetic resonance imaging (MRI) of the brain were performed during assessment in the emergency department. CT of the brain revealed symmetrical hypodensity in bilateral basal ganglia. Diffusion MRI of the brain revealed diffusion restriction not accompanied by hypointensity on apparent diffusion coefficient images in bilateral lentiform nucleus. Mannitol therapy was tapered and discontinued on day 3. The patient was enrolled on a 3-times-weekly HD program. Although the pathophysiology of lentiform fork sign (LFS) is still not fully clear, in our case, LFS may have developed due to insufficient dialysis and consequent metabolic acidosis and uremia. We report this case due to the rarity of LFS.