doi:10.1111/ncn3.12089 PICTURES IN NEUROLOGY Bilateral internal capsule lesions in Acknowledgment uremic encephalopathy The authors declare no conﬂict of interest. A 58-year-old man with immunoglobulin A nephropathy was evaluated for impaired consciousness. A neurological examination revealed disorientation and myoclonus in the References limbs. Blood test showed metabolic acidosis (pH 7.005, 3 1 Albayram S, Ozer H, Gokdemir S et al. Reversible reduction of HCO 6.0 mmol/L), elevated blood urea nitrogen (150 mg/ apparent diffusion coefﬁcient values in bilateral internal capsules dL), elevated creatinine (19.4 mg/dL) and normal blood in transient hypoglycemia-induced hemiparesis. Am. J. sugar levels. Magnetic resonance imaging of the brain Neuroradiol. 2006; 27: 1760–2. showed hyperintense lesions (Fig. 1). The patient completely 2 Kumar G, Goyal MK. Lentiform Fork sign: a unique MRI recovered after hemodialysis. The cause of impaired con- picture. Is metabolic acidosis responsible? Clin. Neurol. sciousness was diagnosed as uremic encephalopathy. Fol- Neurosurg. 2010; 112: 805–12. 3 Kim DM, Lee IH, Song CJ. Uremic encephalopathy: MR low-up magnetic resonance imaging after recovery showed imaging ﬁndings and clinical correlation. AJNR Am. J. that the bilateral internal capsule and left basal ganglia Neuroradiol. 2016 Apr 28. [Epub ahead of print]. lesions remained. Bilateral internal capsule lesions have several possible eti- Takashi Ando, Amane Araki and Shinichi Terao ologies. The patient had renal failure and severe metabolic Department of Neurology, Kasugai Municipal Hospital, Aichi, Japan acidosis. The lentiform fork sign (LFS) has been reported in patients with conditions associated with metabolic acidosis. Yosuke Saka In a recent study, Kim et al. reported that LFS is reliable Department of Internal Medicine, Kasugai Municipal Hospital, in the early diagnosis of uremic encephalopathy, regardless Aichi, Japan of the presence of metabolic acidosis. This lentiform fork Key words: internal capsule lesions, metabolic acidosis, uremic contains bilateral internal capsules. Although the magnetic encephalopathy. resonance imaging ﬁndings in the present patient were not fully consistent with typical LFS, they might have indicated a mild form of LFS. (a) (b) (c) Figure 1 (a) Diffusion-weighted image, (b) T2-weighted image, and (c) ﬂuid-attenuated inversion recovery showed hyperintense lesions in the bilateral basal ganglia, deep white matter and predominantly internal capsule. Correspondence: Dr Takashi Ando, Department of Neurology, Kasugai Municipal Hospital, 1-1-1, Takagi-cho, Kasugai, Aichi 486-8510, Japan. Email: firstname.lastname@example.org Neurology and Clinical Neuroscience 4 (2016) 243 243 ª 2016 Japanese Society of Neurology and John Wiley & Sons Australia, Ltd
Neurology and Clinical Neuroscience – Wiley
Published: Nov 1, 2016
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