Leyole Claudine Ancilla
1 
, Bala Sundaram
2* , Nabadwip Pathak
3 , Arawinth Raj
1 1 Department of Radiodiagnosis, Pondicherry Institute of Medical Sciences, Pondicherry, India
2 Department of General Medicine, Pondicherry Institute of Medical Sciences, Pondicherry, India
3 Department of Nephrology, All India Institute of Medical Science, Bhatinda, Punjab, India
Abstract
Metformin induced encephalopathy is an infrequent but critical neurological complication associated with metformin therapy. Lentiform fork sign, an infrequent radiological imaging (MRI), presents a distinctive image in basal ganglia pathology. It manifests as a V-shaped or fork-like hyperintensity in the globus pallidus and putamen regions. While it has been associated with various conditions like diabetic uremic encephalopathy, toxins like methanol and ethylene glycol, Neurodegenerative etiologies. Its occurrence following metformin administration remains rare because of contraindication of prescribing metformin in a hemodialysis patient due to its well-known side of lactic acidosis. This abstract aims to report and discuss two cases presenting the lentiform forks sign following metformin administration in patients undergoing hemodialysis due to end-stage renal disease. Symptomatic involvement of basal ganglia as metformin induced encephalopathy and resolution with clinical recovery following hemodialysis are rarely reported. We hereby report two such cases which shows symptomatic improvement clinically as well as radiologically following hemodialysis
Implication for health policy/practice/research/medical education:
In this study we discuss two rare cases of metformin-induced encephalopathy in patients undergoing hemodialysis for end-stage renal disease. The lentiform fork sign, a distinctive MRI finding associated with basal ganglia pathology, was observed. Despite metformin’s contraindication in hemodialysis patients due to risk of lactic acidosis, symptomatic improvement was noted following hemodialysis, highlighting the importance of recognizing and managing this rare neurological complication.
Please cite this paper as: Claudine Ancilla L, Sundaram B, Pathak N, Raj A. Twin neurological enigmas radiological and medical insight into a dual encounter with metformin induced encephalopathy. J Nephropharmacol. 2024;13(2):e11681. DOI: 10.34172/npj.2024.11681.