The CT features are quite characteristics for uremic encephalopathy in the correct clinical setting. This patient has newly diagnosed end stage renal failure on dialysis. Upon presentation to emergency department, patient has markedly elevated urea and creatinine as well as severe metabolic acidosis.

Lentiform fork sign is exclusively described for MRI rather than CT scan. It represents bilateral symmetrical hyperintensities in basal ganglia surrounded by hyperintense rim white matter on T2WI and FLAIR sequences. It is postulated to result from metabolic acidosis of any cause.

Otherwise, the vital signs (blood pressure, heart rate and pulse oximetry) were normal. No documented hypotensive episodes as well as no electrocardiogram evidence of myocardiac infarction/ischemia. Therefore, the possibility of anoxic/hypoxic ischemic encephalopathy is lower.