{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T18:34:19Z","timestamp":1789842859212,"version":"4.0.1"},"reference-count":10,"publisher":"Department of Medicine, Warren Alpert Medical School at Brown University","issue":"1","license":[{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>The Lentiform Fork sign is an imaging finding on brain MRI described by bilateral, symmetric hyperintensities in the basal ganglia. It is described in the setting of metabolic acidosis of many etiologies and is a sign of vasogenic edema. Both imaging findings and symptoms are often reversible with correction of the acidosis and removal of any identifiable triggers. We report a case of confusion and ataxic gait in a patient with end stage renal disease and ongoing metformin use. The mechanism of metformin-induced encephalopathy remains unclear, but could be due to vulnerability of mitochondria to metformin within the lentiform nuclei.<\/jats:p>","DOI":"10.56305\/001c.127261","type":"journal-article","created":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T08:25:00Z","timestamp":1735719900000},"source":"Crossref","is-referenced-by-count":5,"title":["Lentiform Fork Sign Secondary To Metformin-Induced Encephalopathy"],"prefix":"10.56305","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8816-7320","authenticated-orcid":false,"given":"Michael A","family":"Santos","sequence":"first","affiliation":[{"name":"Warren Alpert Medical School of Brown University","department":["Department of Medicine"]},{"id":[{"id":"https:\/\/ror.org\/053exzj86","id-type":"ROR","asserted-by":"publisher"}],"name":"Miriam Hospital","department":["Division of Hospital Medicine, Department of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"35509","published-online":{"date-parts":[[2025,1,1]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1111\/j.1542-4758.2012.00698.x","article-title":"Two additional cases of metformin-associated encephalopathy in patients with end-stage renal disease undergoing hemodialysis","volume":"17","author":"Y. 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Kopec","year":"2013","journal-title":"J Med Toxicol"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"100383","DOI":"10.1016\/j.ensci.2021.100383","article-title":"Focal brain lactate accumulation in metformin-induced encephalopathy without systemic lactic acidosis: A case report suggesting mitochondrial vulnerability in lentiform fork sign","volume":"25","author":"A. Hanazono","year":"2021","journal-title":"eNeurologicalSci"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"805","DOI":"10.1016\/j.clineuro.2010.06.006","article-title":"Lentiform Fork sign: a unique MRI picture. Is metabolic acidosis responsible?","volume":"112","author":"G. Kumar","year":"2010","journal-title":"Clin Neurol Neurosurg"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"644","DOI":"10.1001\/jamaneurol.2023.0723","article-title":"Lentiform Fork Sign on Magnetic Resonance Imaging After Methamphetamine and Alcohol Misuse","volume":"80","author":"J. Hiesgen","year":"2023","journal-title":"JAMA Neurol"}],"container-title":["Journal of Brown Hospital Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/bhm.scholasticahq.com\/article\/127261-lentiform-fork-sign-secondary-to-metformin-induced-encephalopathy","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T15:18:24Z","timestamp":1789485504000},"score":1,"resource":{"primary":{"URL":"https:\/\/bhm.scholasticahq.com\/article\/127261-lentiform-fork-sign-secondary-to-metformin-induced-encephalopathy"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,1]]},"references-count":10,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.56305\/001c.127261","relation":{},"ISSN":["2994-5593"],"issn-type":[{"value":"2994-5593","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,1]]}}}