ArticleeNeurologicalSci2021
Focal brain lactate accumulation in metformin-induced encephalopathy without systemic lactic acidosis: A case report suggesting mitochondrial vulnerability in lentiform fork sign.
Article in eNeurologicalSci, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed, 9 citations in OpenAlex.
- A case of metformin-associated encephalopathy in a patient undergoing maintenance hemodialysis.CEN case reports · 2026Article
- Metformin-induced encephalopathy in a peritoneal dialysis patient: the critical role of hemodialysis in reversing lentiform fork sign: a case report.BMC neurology · 2026Article
- Article
- Short-term changes in cerebral perfusion based on three-dimensional arterial spin labeling after treatment of metformin-induced encephalopathy: a case description.Quantitative imaging in medicine and surgery · 2026Article
- Metformin-Associated Encephalopathy as a Rare but Serious Adverse Effect: A Case Report.Cureus · 2026Article
- Lentiform Fork Sign Secondary To Metformin-Induced Encephalopathy.Journal of Brown hospital medicine · 2025Article
- Metformin toxicity: A meta-summary of case reports.World journal of diabetes · 2022Article
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Authors and funding
5 authors at 1 institution in 1 country.
Funding
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Abstract
Metformin causes metabolic encephalopathy in some patients with end-stage chronic kidney disease, resulting in impaired consciousness and parkinsonism. This encephalopathy has a very characteristic magnetic resonance imaging feature in lentiform nuclei known as the "lentiform fork sign". However, the mechanism is unknown. Here, we report a case of metformin-induced encephalopathy with a novel observation of lactate accumulation in the lentiform nuclei on magnetic resonance spectroscopy without systemic lactic acidosis. Since metformin is an inhibitor of mitochondrial complex-I, this focal brain lactate accumulation implies that a part of the pathogenesis of metformin-induced encephalopathy is the focal vulnerability of mitochondria to metformin in the lentiform nuclei. When metformin causes encephalopathy, not only testing for serum lactic acidosis and performing routine magnetic resonance imaging but also evaluation of brain lactate accumulation by magnetic resonance spectroscopy should be required to elucidate the etiology.
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