Presentation
Chronic renal failure with a decreased level of consciousness and lower limb edematous changes.
Patient Data
Bilateral symmetrical swelling with characteristic T2/FLAIR hyperintensity of the caudate and lentiform nuclei surrounded by a hyperintense rim delineating the lentiform nucleus giving the appearance of lentiform fork sign.
Multifocal areas of cortical and subcortical hyperintensities along with both cerebral and cerebellar hemispheres are noted.
T2/FLAIR hyperintensity also is seen at pons mid to anterior aspect.
No evidence of restricted diffusion is seen, however characteristically elevated ADC signal is seen involving the internal and external capsules.
Case Discussion
Uremic encephalopathy typically presents as bilateral T2/FLAIR hyperintensities involving the basal ganglia, thalamus, midbrain, and mesial temporal lobes. Restricted diffusion may or may not be present to a varying degree, but is not characteristic of uremic encephalopathy. Enhancement is not a typical feature. lentiform fork sign is a characteristic feature of uremic encephalopathy, in which the white matter surrounding the basal ganglia - the internal and external capsules and the medullary laminae - become hyperintense on T2/FLAIR.