Lentiform fork sign: A magnetic resonance finding in a case of acute metabolic acidosis

Daniela Grasso, Carmela Borreggine, Francesco Perfetto, Vincenzo Bertozzi, Marina Trivisano, Luigi Maria Specchio, Gianpaolo Grilli, Luca Macarini

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish
Pages (from-to)288-292
Number of pages5
JournalNeuroradiology Journal
Issue number3
Publication statusPublished - 2014


  • Diffusion-weighted imaging
  • Lentiform fork sign
  • Metabolic acidosis
  • MRI
  • Putaminal necrosis

ASJC Scopus subject areas

  • Clinical Neurology
  • Radiology Nuclear Medicine and imaging


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