“Lentiform fork sign” in uremic striatopallidal syndrome: a rare cause of parkinsonism

An 88-year-old diabetic man, with end-stage chronic kidney disease, on dialysis, presented with nausea and diarrhea for 2 days. After this period, the patient's family sought emergency care due to a significant and acute reduction in movement, dysphonia, and dysphagia. His physical examination was consistent with akinetic-rigid parkinsonian syndrome. A brain magnetic resonance imaging scan was performed, and the lentiform fork sign was identified ([Figure 1]), which, associated with metabolic acidosis, corroborated the diagnosis of uremic striatopallidal syndrome.