title: Lentiform fork sign: a magnetic resonance finding in a case of acute metabolic acidosis.
abstract: We report a 33 year-old woman addicted to chronic unspecified solvents abuse with stupor, respiratory disorders, tetraplegia and severe metabolic acidosis. On admission an unenhanced cranial CT scan showed symmetrical hypodensities of both lentiform nuclei. 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.
authors: Department of Imaging Diagnostics, University of Foggia; Foggia, Italy - daniela.grasso@hotmail.it.
authors: Daniela
authors: D
authors: Grasso
authors: Specialisation School in Radiodiagnostics, University of Foggia; Foggia, Italy.
authors: Carmela
authors: C
authors: Borreggine
authors: Radiodiagnostic Unit, "Ospedali Riuniti" University Hospital; Foggia, Italy.
authors: Francesco
authors: F
authors: Perfetto
authors: Radiodiagnostic Unit, "Ospedali Riuniti" University Hospital; Foggia, Italy.
authors: Vincenzo
authors: V
authors: Bertozzi
authors: Specialisation School in Neurology, University of Foggia; Foggia, Italy.
authors: Marina
authors: M
authors: Trivisano
authors: Specialisation School in Neurology, University of Foggia; Foggia, Italy.
authors: Luigi Maria
authors: LM
authors: Specchio
authors: Radiodiagnostic Unit, "Ospedali Riuniti" University Hospital; Foggia, Italy.
authors: Gianpaolo
authors: G
authors: Grilli
authors: Specialisation School in Radiodiagnostics, University of Foggia; Foggia, Italy.
authors: Luca
authors: L
authors: Macarini
mesh_terms: D000138:Acidosis / Q000473:pathology*; D000208:Acute Disease; D000328:Adult; D001928:Brain Diseases, Metabolic / Q000473:pathology*; D003342:Corpus Striatum / Q000473:pathology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male
keywords: MRI; diffusion-weighted imaging; lentiform fork sign; metabolic acidosis; putaminal necrosis