Relevance of ‘Lentiform fork sign’ on MRI in definitive early diagnosis of uremic encephalopathy

ABSTRACT Introduction: Uremic encephalopathy (UE) is a metabolic and neurological disorder related to end-stage renal disease (ESRD) and is frequently associated with metabolic acidosis. Typical imaging findings in the form of Lentiform fork sign under the gamut of ‘Central posterior reversible encephalopathy syndrome’ have been considered specific in early diagnosis of UE. Methods: This descriptive hospital-based cross-sectional study was done including 23 patients with ESRD who were diagnosed as having UE over a period of 2 years, with a review of their clinical presentation, biochemical profiles, and imaging findings. Results: In patients with metabolic acidosis due to ESRD on irregular treatment, the Lentiform fork sign is characteristic and representative of a definitive diagnosis of UE. Conclusion: The affliction of the basal ganglia to severe metabolic acidosis and uremia makes the Lentiform fork sign a characteristic sign to diagnose UE in patients with ESRD on irregular treatment. Characteristic imaging findings contribute to establish a definitive diagnosis of UE and help institute early treatment to curtail mortality in such cases.