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MR imaging performed 12 hours after stupor demonstrates bilateral putaminal hemorrhagic necrosis, bilateral external capsule, corona radiata and deep cerebellar hyperintensities with right cingulate cortex involvement. DWI reflected bilateral putaminal hyperintensities with restricted water diffusion as to citotoxic edema and development of vasogenic edema in the external capsule recalling a fork. On day twenty, after specific treatments MRI demonstrated a bilateral putaminal marginal enhancement. Bilateral putaminal necrosis is a characteristic but non-specific radiological finding of methanol poisoning. Lentiform Fork sign is a rare MRI finding reported in literature in 22 patients with various conditions characterized by metabolic acidosis. Vasogenic edema may be due to the differences in metabolic vulnerability between neurons and astrocytes. We postulate that metabolic acidosis could have an important role to generate this sign.<\/jats:p>","DOI":"10.15274\/nrj-2014-10041","type":"journal-article","created":{"date-parts":[[2014,4,18]],"date-time":"2014-04-18T17:47:57Z","timestamp":1397843277000},"page":"288-292","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":39,"title":["Lentiform Fork Sign: A Magnetic Resonance Finding in a Case of Acute Metabolic Acidosis"],"prefix":"10.1177","volume":"27","author":[{"given":"Daniela","family":"Grasso","sequence":"first","affiliation":[{"name":"Department of Imaging Diagnostics, University of Foggia; Foggia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmela","family":"Borreggine","sequence":"additional","affiliation":[{"name":"Specialisation School in Radiodiagnostics, University of Foggia; Foggia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Perfetto","sequence":"additional","affiliation":[{"name":"Radiodiagnostic Unit, \u201cOspedali Riuniti\u201d University Hospital; Foggia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincenzo","family":"Bertozzi","sequence":"additional","affiliation":[{"name":"Radiodiagnostic Unit, \u201cOspedali Riuniti\u201d University Hospital; Foggia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marina","family":"Trivisano","sequence":"additional","affiliation":[{"name":"Specialisation School in Neurology, University of Foggia; Foggia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luigi Maria","family":"Specchio","sequence":"additional","affiliation":[{"name":"Specialisation School in Neurology, University of Foggia; Foggia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianpaolo","family":"Grilli","sequence":"additional","affiliation":[{"name":"Radiodiagnostic Unit, \u201cOspedali Riuniti\u201d University Hospital; Foggia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Macarini","sequence":"additional","affiliation":[{"name":"Specialisation School in Radiodiagnostics, University of Foggia; Foggia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2014,6]]},"reference":[{"key":"e_1_2_1_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0733-8619(05)70217-6"},{"key":"e_1_2_1_3_2","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.2214\/AJR.07.7089","article-title":"Radiological reasoning: Hyperintensity of the basal ganglia and cortex on FLAIR and diffusion-weighted imaging","volume":"195","author":"Beltz EE","year":"2010","unstructured":"Beltz EE, Mullins ME. 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