Uremic encephalopathy

Case contributed by Zentout Sofiane
Diagnosis almost certain


Chronic renal failure on hemodialysis with acute dysarthria and confusion.

Patient Data

Age: 70 years.
Gender: Male

MRI demonstrates bilateral T2/flair and DWI hyperintensity of the lentiform nuclei, with hyperintense rim delineating the lentiform nucleus " lentiform fork sign"

Gyriform high signal T2/Flair/DWI in the left precentral and postcentral gyrus cortex.

There is no evidence of restricted diffusion.

Case Discussion

The basal ganglia are metabolically highly active and are susceptible to a large variety of toxins and metabolic disorders.

Metabolic acidosis, generally found in these disorders, is the major factor and the key to the pathogenesis of the lentiform fork sign.

Uremic encephalopathy is a complication caused by the accumulation of toxins in patients with severe acute or chronic renal failure.

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