Lentiform fork sign in a uremic patient after inadvertent exposure to metformin

Yen An Chang, Der-Cherng Tarng, Chih Yu Yang*

*Corresponding author for this work

Research output: Contribution to journalComment/debate

2 Scopus citations


This case report describes a 56-year-old woman receiving regular hemodialysis for three years who presented with an unsteady gait for one month, dysarthria, and frequent choking on liquids for two weeks. Brain MRI revealed a characteristic “lentiform fork sign” with hyperintense T2W/FLAIR signal in the bilateral lentiform nuclei and restricted diffusion in bilateral globus pallidus. She was inadvertently prescribed metformin 1,000 mg per day one month ago by a physician who was unaware of her end-stage kidney disease. After intensive hemodialysis therapy with eight hemodialysis sessions within 12 days, her neurological deficits fully resolved. Clinicians should be aware of metformin-induced encephalopathy, presenting with relevant medication history, neurological symptoms, and the lentiform fork sign.

Original languageEnglish
Pages (from-to)406-407
Number of pages2
JournalClinical Toxicology
Issue number3
StatePublished - 2022


  • encephalopathy
  • End-stage kidney disease
  • lentiform nucleus
  • metabolic acidosis
  • metformin


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