{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T21:59:21Z","timestamp":1776722361901,"version":"3.51.2"},"reference-count":16,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T00:00:00Z","timestamp":1774310400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"},{"start":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T00:00:00Z","timestamp":1776297600000},"content-version":"vor","delay-in-days":23,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Neurol"],"DOI":"10.1186\/s12883-026-04824-6","type":"journal-article","created":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T10:18:16Z","timestamp":1774347496000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Metformin-induced encephalopathy in a peritoneal dialysis patient: the critical role of hemodialysis in reversing lentiform fork sign: a case report"],"prefix":"10.1186","volume":"26","author":[{"given":"Haoyuan","family":"Ma","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaoxuan","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaofang","family":"Cheng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Litao","family":"Gao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jianxia","family":"Zhi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lianyuan","family":"Feng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shusheng","family":"Jiao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,3,24]]},"reference":[{"key":"4824_CR1","doi-asserted-by":"publisher","first-page":"e935730","DOI":"10.12659\/AJCR.935730","volume":"23","author":"L Rueda Prada","year":"2022","unstructured":"Rueda Prada L, et al. Transient complete blindness due to Metformin-Associated Lactic Acidosis (MALA) reversed with hemodialysis. Am J Case Rep. 2022;23:e935730.","journal-title":"Am J Case Rep"},{"issue":"6","key":"4824_CR2","doi-asserted-by":"publisher","first-page":"359","DOI":"10.1093\/qjmed\/hcab140","volume":"115","author":"R Manickavasagar","year":"2022","unstructured":"Manickavasagar R, et al. The extrapyramidal syndromes of chronic kidney disease and dialysis (EPS-CKDD): diagnostic criteria, risk factors and prognosis. QJM. 2022;115(6):359\u201366.","journal-title":"QJM"},{"issue":"6","key":"4824_CR3","doi-asserted-by":"publisher","first-page":"783","DOI":"10.1007\/s40620-016-0267-8","volume":"29","author":"A Moioli","year":"2016","unstructured":"Moioli A, et al. Metformin associated lactic acidosis (MALA): clinical profiling and management. J Nephrol. 2016;29(6):783\u20139.","journal-title":"J Nephrol"},{"issue":"9","key":"4824_CR4","doi-asserted-by":"publisher","first-page":"805","DOI":"10.1016\/j.clineuro.2010.06.006","volume":"112","author":"G Kumar","year":"2010","unstructured":"Kumar G, Goyal MK. Lentiform fork sign: a unique MRI picture. Is metabolic acidosis responsible? Clin Neurol Neurosurg. 2010;112(9):805\u201312.","journal-title":"Clin Neurol Neurosurg"},{"issue":"2","key":"4824_CR5","doi-asserted-by":"publisher","first-page":"194","DOI":"10.1111\/imj.13693","volume":"48","author":"C McGarvey","year":"2018","unstructured":"McGarvey C, et al. Metformin-induced encephalopathy: the role of thiamine. Intern Med J. 2018;48(2):194\u20137.","journal-title":"Intern Med J"},{"key":"4824_CR6","doi-asserted-by":"publisher","first-page":"969","DOI":"10.12688\/f1000research.25597.1","volume":"9","author":"Y Ishizaki","year":"2020","unstructured":"Ishizaki Y, et al. Case report: a case of encephalopathy presenting the lentiform fork sign on MRI in a diabetic dialysis patient. F1000Res. 2020;9:969.","journal-title":"F1000Res"},{"key":"4824_CR7","doi-asserted-by":"publisher","first-page":"100383","DOI":"10.1016\/j.ensci.2021.100383","volume":"25","author":"A Hanazono","year":"2021","unstructured":"Hanazono A, et al. Focal brain lactate accumulation in metformin-induced encephalopathy without systemic lactic acidosis: a case report suggesting mitochondrial vulnerability in lentiform fork sign. eNeurologicalSci. 2021;25:100383.","journal-title":"eNeurologicalSci"},{"issue":"1","key":"4824_CR8","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1111\/hdi.13113","volume":"28","author":"S Kim","year":"2024","unstructured":"Kim S, et al. Metformin-associated lactic acidosis (MALA): is it an underestimated entity? A retrospective, single-center case series. Hemodial Int. 2024;28(1):32\u20139.","journal-title":"Hemodial Int"},{"issue":"s1","key":"4824_CR9","doi-asserted-by":"publisher","first-page":"S11","DOI":"10.3233\/JPD-179006","volume":"7","author":"JW Langston","year":"2017","unstructured":"Langston JW. The MPTP Story. J Parkinsons Dis. 2017;7(s1):S11-s19.","journal-title":"J Parkinsons Dis"},{"issue":"1","key":"4824_CR10","doi-asserted-by":"publisher","first-page":"55","DOI":"10.5301\/jn.5000166","volume":"26","author":"A Rocha","year":"2013","unstructured":"Rocha A, et al. Metformin in patients with chronic kidney disease: strengths and weaknesses. J Nephrol. 2013;26(1):55\u201360.","journal-title":"J Nephrol"},{"issue":"1","key":"4824_CR11","doi-asserted-by":"publisher","first-page":"e221602","DOI":"10.1148\/radiol.221602","volume":"307","author":"DA Lizarazo","year":"2023","unstructured":"Lizarazo DA, Lizarazo J. Uremic encephalopathy. Radiology. 2023;307(1):e221602.","journal-title":"Radiology"},{"issue":"3","key":"4824_CR12","doi-asserted-by":"publisher","first-page":"194","DOI":"10.4103\/ijn.IJN_257_17","volume":"29","author":"SP Simon","year":"2019","unstructured":"Simon SP, Thomas J. Metformin-associated encephalopathy in hemodialysis. Indian J Nephrol. 2019;29(3):194\u20136.","journal-title":"Indian J Nephrol"},{"issue":"9","key":"4824_CR13","first-page":"e44850","volume":"15","author":"A Ali","year":"2023","unstructured":"Ali A, et al. An irreversible radiological finding of lentiform fork sign in a patient with uremic encephalopathy: a case report. Cureus. 2023;15(9):e44850.","journal-title":"Cureus"},{"issue":"11","key":"4824_CR14","first-page":"e74339","volume":"16","author":"F Albadr","year":"2024","unstructured":"Albadr F, et al. Uremic encephalopathy presented as stroke: the value of lentiform fork sign. Cureus. 2024;16(11):e74339.","journal-title":"Cureus"},{"issue":"3","key":"4824_CR15","doi-asserted-by":"publisher","first-page":"547","DOI":"10.2337\/dc17-2231","volume":"41","author":"JD Lalau","year":"2018","unstructured":"Lalau JD, et al. Metformin treatment in patients with type 2 diabetes and chronic kidney disease stages 3A, 3B, or 4. Diabetes Care. 2018;41(3):547\u201353.","journal-title":"Diabetes Care"},{"issue":"1","key":"4824_CR16","doi-asserted-by":"publisher","first-page":"38","DOI":"10.56305\/001c.127261","volume":"4","author":"MA Santos","year":"2025","unstructured":"Santos MA. Lentiform fork sign secondary to Metformin-induced encephalopathy. J Brown Hosp Med. 2025;4(1):38\u201340.","journal-title":"J Brown Hosp Med"}],"container-title":["BMC Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12883-026-04824-6","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12883-026-04824-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12883-026-04824-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T13:46:25Z","timestamp":1776347185000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12883-026-04824-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,24]]},"references-count":16,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["4824"],"URL":"https:\/\/doi.org\/10.1186\/s12883-026-04824-6","relation":{},"ISSN":["1471-2377"],"issn-type":[{"value":"1471-2377","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,24]]},"assertion":[{"value":"22 November 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 March 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 March 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was approved by the Medical Ethics Committee of Bethune International Peace Hospital (Approval No. 2023-KY-96). Written informed consent to participate in the study was provided by participant.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written informed consent for publication was obtained from the patient.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"256"}}