Lentiform fork sign: Uremia alone or multifactorial causation?

Area of Science:

• Nephrology
• Neurology
• Internal Medicine

Background:

• Neurological complications frequently occur in patients with acute or chronic renal failure, particularly with reduced glomerular filtration rate (GFR).
• Uremic encephalopathy (UE) is a clinical syndrome resulting from widespread central nervous system (CNS) dysfunction in renal failure.
• Asterixis (flapping tremor) is a common bedside finding suggestive of UE.

Observation:

• This report presents a rare case of symptomatic basal ganglia involvement in a patient with uremic encephalopathy.
• The patient exhibited choreoathetosis, a movement disorder affecting the basal ganglia.
• Clinical and radiological findings showed resolution following hemodialysis treatment.

Findings:

• The case highlights the potential for basal ganglia dysfunction, specifically choreoathetosis, as a manifestation of uremic encephalopathy.
• Hemodialysis proved effective in resolving both the neurological symptoms and radiological abnormalities associated with this rare presentation.
• This underscores the importance of considering neurological involvement in the spectrum of uremic encephalopathy.

Implications:

• This case expands the understanding of the diverse neurological manifestations of renal failure.
• It emphasizes the critical role of timely and effective renal replacement therapy, such as hemodialysis, in managing complex neurological complications.
• Further research into the specific mechanisms linking uremia to basal ganglia dysfunction may offer new therapeutic targets.