Extrapyramidal syndromes of chronic kidney disease and dialysis (diabetic uremic syndrome) with reversible parkinsonism and lentiform fork sign: A case report and literature review including metformin-induced encephalopathy

Sakurai, Takeo; Nishida, Hiroshi

doi:10.1016/j.heliyon.2023.e14255

Cited by 1 publication

(2 citation statements)

References 23 publications

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“…Wang et al. were the first to propose a condition called “Diabetic uremic syndrome” in diabetic patients who have end‐stage renal disease, complaining of neurological symptoms, and bilateral basal ganglia lesions 4,5 …”

Section: Discussionmentioning

confidence: 99%

“…Wang et al were the first to propose a condition called "Diabetic uremic syndrome" in diabetic patients who have end-stage renal disease, complaining of neurological symptoms, and bilateral basal ganglia lesions. 4,5 Manickavasagar et al 6 suggested the term "extrapyramidal syndromes of chronic kidney disease and dialysis (EPS-CKDD)" in a retrospective case series review of 20 patients receiving dialysis. The diagnostic criteria were based on the presentation of an acute extrapyramidal movement disorder manifesting either as hypokinetic acute parkinsonism or a hyperkinetic form with acute chorea/athetosis associated with bilateral basal ganglia injury.…”

Section: Discussionmentioning

confidence: 99%

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Uremic encephalopathy manifesting with a unique MRI finding (the lentiform fork sign) in an adult male: A case report

Alhusseini,

Hamsho,

Alabdullah

et al. 2023

Clinical Case Reports

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Key Clinical MessageA novel radiologic sign in patients with renal failure and uremic encephalopathy (UE) with metabolic acidosis has recently been identified as the lentiform fork sign. On magnetic resonance imaging (MRI), the “lentiform fork sign” has been described as bilateral symmetrical hyperintensities in the basal ganglia encircled by a hyperintese rim delineating the lentiform nucleus. Changes in uremic solute retention, aberrant blood–brain barrier transport, disordered vascular reactivity, altered electrolyte and acid–base balance, and altered hormone metabolism are the most likely causes of the condition. A 56‐year‐old male with end‐stage renal disease was brought to the emergency room for a progressive change in mental status and involuntary arm movements over the previous 5 days, which were accompanied by mild dyspnea. A brain MRI was performed, and it revealed hyperintensity on T2/FLAIR in the white matter surrounding the basal ganglia. the patient was treated with dialysis and improved greatly. Intensified hemodialysis and glycemic control are the cornerstones of treating diabetic uremic syndrome (DUS) with likely reversible clinical symptoms and remission of imaging abnormalities.

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Section: Discussionmentioning

confidence: 99%