Lentiform fork sign in a girl with uremic encephalopathy

Diffusion-weighted imaging in methanol poisoning: beyond the lentiform fork sign

INTRODUCTION

Methanol poisoning is a life-threatening emergency, in which the presence of a lentiform fork sign on magnetic resonance imaging, although not exclusive to methanol poisoning, can be of diagnostic assistance. This report highlights the additional value of diffusion-weighted imaging in methanol poisoning.

CASE SUMMARY

A 38-year-old man was admitted to the hospital with severe metabolic acidosis, coma and visual disturbances due to methanol poisoning.

IMAGES

Initial computed tomography of the brain was unremarkable. However, magnetic resonance imaging revealed the lentiform fork sign, with diffusion-weighted imaging changes in the lentiform nuclei.

CONCLUSION

Diffusion-weighted imaging sequences provide additional information compared to traditional magnetic resonance imaging in assessing methanol poisoning. Systematic evaluation is needed to fully understand and utilize the potential predictive value of diffusion-weighted imaging in this context.

Uremic encephalopathy: A definite diagnosis by magnetic resonance imaging?

The aim of this study was to investigate the magnetic resonance imaging (MRI) findings for the diagnose uremic encephalopathy and describe the usefulness of MRI findings in the ultimate diagnosis of uremic encephalopathy (UE). A total of 20 patients with uremic encephalopathy admitted to the hospital were evaluated in this prospective study. The clinical manifestations, laboratory and MRI imaging findings, demographic information, and clinical outcome were analyzed for each patient. We observed that the 20 prospectively reviewed patients with UE had no involvement of the basal ganglia or the lentiform fork sign (LFS). However, two-thirds of the patients had white matter involvement, and 80% of the subjects had cerebral or cortical atrophy. The arterial blood gas (ABG) analysis revealed that 50% of the patients suffered from metabolic acidosis (n=10). The results of the present study demonstrated that although the observation of Lentiform Fork Sign and Basal Ganglia involvement in MRI of UE patients is a specific finding the absence of which does not rule out UE. Thus, simultaneous examination of clinical manifestation and laboratory test analyses, along with imaging findings, should also be taken into account.