The subcortical gray matter is known to be exquisitely sensitive to a range of toxins and metabolic disturbances ¹. Uremic encephalopathy (UE) is an acquired toxic syndrome related to kidney dysfunction. Whereas the literature concerning encephalopathy associated with liver disease is rich and multifaceted, there are very few studies dealing with this aspect of renal failure, thus little is known of the pathophysiology of UE. The complexity of normal kidney function, however, makes it likely that renal failure leads to a variety of abnormalities that exert synergistic deleterious effects on the brain ². Metabolic acidosis has been proposed as a possible mechanism for UE, which is associated with the lentiform fork sign on MRI ³.