{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T23:07:09Z","timestamp":1774566429228,"version":"3.50.1"},"reference-count":20,"publisher":"Springer Science and Business Media LLC","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,17]]},"DOI":"10.7759\/cureus.101758","type":"journal-article","created":{"date-parts":[[2026,1,18]],"date-time":"2026-01-18T06:31:02Z","timestamp":1768717862000},"source":"Crossref","is-referenced-by-count":2,"title":["Metformin-Associated Encephalopathy as a Rare but Serious Adverse Effect: A Case Report"],"prefix":"10.7759","author":[{"given":"Anna","family":"Aoki","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daisuke","family":"Mizu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hidenori","family":"Higashi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jumpei","family":"Yamashita","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.4239\/wjd.v13.i8.654","article-title":"Metformin toxicity: a meta-summary of case reports","volume":"13","author":"Juneja D","year":"2022","unstructured":"Juneja D, Nasa P, Jain R. Metformin toxicity: a meta-summary of case reports. World J Diabetes. 2022, 13:654-64. 10.4239\/wjd.v13.i8.654","journal-title":"World J Diabetes"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jemermed.2023.11.017","article-title":"Metformin-associated lactic acidosis-is this on your radar?","volume":"66","author":"Simon EL","year":"2024","unstructured":"Simon EL, Sherry AC, Rabinowitz J. Metformin-associated lactic acidosis-is this on your radar?. J Emerg Med. 2024, 66:e530-3. 10.1016\/j.jemermed.2023.11.017","journal-title":"J Emerg Med"},{"key":"ref3","doi-asserted-by":"publisher","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":"Kang YJ","year":"2013","unstructured":"Kang YJ, Bae EJ, Seo JW, et al.. Two additional cases of metformin-associated encephalopathy in patients with end-stage renal disease undergoing hemodialysis. Hemodial Int. 2013, 17:111-15. 10.1111\/j.1542-4758.2012.00698.x","journal-title":"Hemodial Int"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1016\/j.metabol.2015.10.014","article-title":"Metformin-associated lactic acidosis: Current perspectives on causes and risk","volume":"65","author":"DeFronzo R","year":"2016","unstructured":"DeFronzo R, Fleming GA, Chen K, Bicsak TA. Metformin-associated lactic acidosis: Current perspectives on causes and risk. Metabolism. 2016, 65:20-9. 10.1016\/j.metabol.2015.10.014","journal-title":"Metabolism"},{"key":"ref5","unstructured":"FDA Drug safety communications. (2025). Accessed. September 30, 2025: https:\/\/www.fda.gov\/media\/96771\/download."},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1016\/j.jdiacomp.2019.107423","article-title":"Antidiabetic medication use in patients with type 2 diabetes and chronic kidney disease","volume":"33","author":"Rhee JJ","year":"2019","unstructured":"Rhee JJ, Han J, Montez-Rath ME, et al.. Antidiabetic medication use in patients with type 2 diabetes and chronic kidney disease. J Diabetes Complications. 2019, 33:107423. 10.1016\/j.jdiacomp.2019.107423","journal-title":"J Diabetes Complications"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.2337\/dc25-S009","article-title":"9. Pharmacologic approaches to glycemic treatment: standards of care in diabetes-2025","volume":"48","year":"2025","unstructured":"9. Pharmacologic approaches to glycemic treatment. standards of care in diabetes-2025. Diabetes Care. 2025, 48:S181-206. 10.2337\/dc25-S009","journal-title":"Diabetes Care"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.56305\/001c.127261","article-title":"Lentiform fork sign secondary to metformin-induced encephalopathy","volume":"4","author":"Santos MA","year":"2025","unstructured":"Santos MA. Lentiform fork sign secondary to metformin-induced encephalopathy. J Brown Hosp Med. 2025, 4:38-40. 10.56305\/001c.127261","journal-title":"J Brown Hosp Med"},{"key":"ref9","doi-asserted-by":"publisher","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":"Hanazono A","year":"2021","unstructured":"Hanazono A, Takahashi Y, Sanpei Y, Kamada S, Sugawara M. 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. 10.1016\/j.ensci.2021.100383","journal-title":"eNeurologicalSci"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1016\/j.clineuro.2010.06.006","article-title":"Lentiform Fork sign: a unique MRI picture. Is metabolic acidosis responsible?","volume":"112","author":"Kumar G","year":"2010","unstructured":"Kumar G, Goyal MK. Lentiform Fork sign: a unique MRI picture. Is metabolic acidosis responsible?. Clin Neurol Neurosurg. 2010, 112:805-12. 10.1016\/j.clineuro.2010.06.006","journal-title":"Clin Neurol Neurosurg"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2023.0723","article-title":"Lentiform fork sign on magnetic resonance imaging after methamphetamine and alcohol misuse","volume":"80","author":"Hiesgen J","year":"2023","unstructured":"Hiesgen J, Badenhorst J.  Lentiform fork sign on magnetic resonance imaging after methamphetamine and alcohol misuse. JAMA Neurol. 2023, 80:644-45. 10.1001\/jamaneurol.2023.0723","journal-title":"JAMA Neurol"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.74339","article-title":"Uremic encephalopathy presented as stroke: the value of lentiform fork sign","volume":"16","author":"Albadr F","year":"2024","unstructured":"Albadr F, Alqadeeb AS, Alzaid WS, Alalwan FA, Alomar YA, Alomar MA, Bafarat AM. Uremic encephalopathy presented as stroke: the value of lentiform fork sign. Cureus. 2024, 16:e74339. 10.7759\/cureus.74339","journal-title":"Cureus"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.4103\/ijn.IJN_257_17","article-title":"Metformin-associated encephalopathy in hemodialysis","volume":"29","author":"Simon SP","year":"2019","unstructured":"Simon SP, Thomas J. Metformin-associated encephalopathy in hemodialysis. Indian J Nephrol. 2019, 29:194-96. 10.4103\/ijn.IJN_257_17","journal-title":"Indian J Nephrol"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.1002\/ccr3.8233","article-title":"Uremic encephalopathy manifesting with a unique MRI finding (the lentiform fork sign) in an adult male: A case report","volume":"11","author":"Alhusseini A","year":"2023","unstructured":"Alhusseini A, Hamsho S, Alabdullah H, Alaswad M, Sleiay M, Alsamarrai O. Uremic encephalopathy manifesting with a unique MRI finding (the lentiform fork sign) in an adult male: A case report. Clin Case Rep. 2023, 11:e8233. 10.1002\/ccr3.8233","journal-title":"Clin Case Rep"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.1111\/j.1542-4758.2009.00358.x","article-title":"Metformin-induced encephalopathy without lactic acidosis in a patient with contraindication for metformin","volume":"13","author":"Jung EY","year":"2009","unstructured":"Jung EY, Cho HS, Seo JW, Kim DW, Kim HJ, Chang SH, Park DJ. Metformin-induced encephalopathy without lactic acidosis in a patient with contraindication for metformin. Hemodial Int. 2009, 13:172-75. 10.1111\/j.1542-4758.2009.00358.x","journal-title":"Hemodial Int"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.1016\/j.heliyon.2023.e14255","article-title":"Extrapyramidal syndromes of chronic kidney disease and dialysis (diabetic uremic syndrome) with reversible parkinsonism and lentiform fork sign: A case report and literature review including metformin-induced encephalopathy","volume":"9","author":"Sakurai T","year":"2023","unstructured":"Sakurai T, Nishida H. Extrapyramidal syndromes of chronic kidney disease and dialysis (diabetic uremic syndrome) with reversible parkinsonism and lentiform fork sign: A case report and literature review including metformin-induced encephalopathy. Heliyon. 2023, 9:e14255. 10.1016\/j.heliyon.2023.e14255","journal-title":"Heliyon"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.12688\/f1000research.25597.3","article-title":"A case of encephalopathy presenting the lentiform fork sign on MRI in a diabetic dialysis patient","volume":"9","author":"Ishizaki Y","year":"2020","unstructured":"Ishizaki Y, Nishizono R, Kikuchi M, Inagaki H, Sato Y, Fujimoto S. A case of encephalopathy presenting the lentiform fork sign on MRI in a diabetic dialysis patient. F1000Res. 2020, 9:969. 10.12688\/f1000research.25597.3","journal-title":"F1000Res"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.12659\/PJR.899960","article-title":"Various imaging manifestations of posterior reversible encephalopathy syndrome (PRES) on magnetic resonance imaging (MRI)","volume":"82","author":"Raman R","year":"2017","unstructured":"Raman R, Devaramane R, Jagadish GM, Chowdaiah S. Various imaging manifestations of posterior reversible encephalopathy syndrome (PRES) on magnetic resonance imaging (MRI). Pol J Radiol. 2017, 82:64-70. 10.12659\/PJR.899960","journal-title":"Pol J Radiol"},{"key":"ref19","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-003-1122-0","article-title":"The syndrome of acute bilateral basal ganglia lesions in diabetic uremic patients","volume":"250","author":"Wang HC","year":"2003","unstructured":"Wang HC, Cheng SJ. The syndrome of acute bilateral basal ganglia lesions in diabetic uremic patients. J Neurol. 2003, 250:948-55. 10.1007\/s00415-003-1122-0","journal-title":"J Neurol"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.1093\/qjmed\/hcab140","article-title":"The extrapyramidal syndromes of chronic kidney disease and dialysis (EPS-CKDD): diagnostic criteria, risk factors and prognosis","volume":"115","author":"Manickavasagar R","year":"2022","unstructured":"Manickavasagar R, Chemmanam T, Youssef A, Agarwal A, Prentice DA, Irish AB. The extrapyramidal syndromes of chronic kidney disease and dialysis (EPS-CKDD): diagnostic criteria, risk factors and prognosis. QJM. 2022, 115:359-66. 10.1093\/qjmed\/hcab140","journal-title":"QJM"}],"container-title":["Cureus"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cureus.com\/articles\/452050-metformin-associated-encephalopathy-as-a-rare-but-serious-adverse-effect-a-case-report","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,18]],"date-time":"2026-01-18T06:31:03Z","timestamp":1768717863000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cureus.com\/articles\/452050-metformin-associated-encephalopathy-as-a-rare-but-serious-adverse-effect-a-case-report"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,17]]},"references-count":20,"URL":"https:\/\/doi.org\/10.7759\/cureus.101758","relation":{},"ISSN":["2168-8184"],"issn-type":[{"value":"2168-8184","type":"print"}],"subject":[],"published":{"date-parts":[[2026,1,17]]}}}