Lentiform fork sign: A distinctive neuroradiologic manifestation of uremic encephalopathy—A case report

Introduction: The lentiform fork sign is a unique magnetic resonance imaging (MRI) appearance of the basal ganglia believed to be due to acute metabolic acidosis and seen in several conditions that result in metabolic acidosis such as uremic encephalopathy. Case Report: We present the case of a 76-year-old hypertensive and diabetic male patient with end-stage renal failure on dialysis, whose brain MRI revealed bilateral symmetrical T2W and fluid-attenuated inversion recovery hyperintensities in the basal ganglia, surrounded by a hyperintense rim delineating the lentiform nuclei, giving rise to the lentiform fork sign. Conclusion: We describe this under-reported unique sign, the lentiform fork sign, in an end-stage renal disease patient, whose brain MRI revealed this sign to highlight the significance of this sign, which has been widely reported to be associated with uremic encephalopathy.