case_images: PMC8602957_01
case_images: a,
  e Head computed tomography (CT) and
  b-d head MRI (T2-weighted image).
  a, b High-resolution lesions in the bilateral symmetrical basal ganglia were evident at admission.
  c, d The bilateral symmetrical basal ganglia lesions gradually improved on the 18
  th hospital day and at three-month follow-up.
  e However, the basal ganglia lesions remained at eight-month follow-up.
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case_images: PMC8602957_01_f1000research-9-79872-g0000.jpg
case_images: f1
case_images: However, bilateral symmetrical basal ganglia lesions were noted on brain CT ( Figure 1a). T2-weighted brain MRI revealed a modest improvement in the lentiform fork sign ( Figure 1c). The patient was gradually able to sitting alone, walk, and talk with staff and his wife. At three-month follow-up, the lentiform fork sign was further improved on brain MRI ( Figure 1d). Brain lesions were still evident on CT scan ( Figure 1e).
case_images: The patient started metformin treatment at six months prior to admission.. Since that time, he developed gradual symptoms of sluggish speaking and dysarthria, while numbness of his left upper limb, gait disturbance, and consciousness disturbance appeared 10 days before admission. He received emergency consecutive hemodialysis for six days, after which he awoke, and was gradually able to walk and talk. *Walking was possible, but wobbling during walking remained at eight-month follow-up.
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case_images: PMC8602957_01_f1000research-9-79872-g0001.jpg
case_images: f2
case_images: His wife said that his sluggish speaking and dysarthria appeared gradually after starting metformin treatment ( Figure 2).