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Fogging phenomenon (cerebral infarct)

Andrew Murphy ◉ and A.Prof Frank Gaillard ◉ ◈ et al.

The fogging phenomenon is seen on non-contrast CT of the brain and represents a transient phase of the evolution of cerebral infarct where the region of cortical infarction regains a near-normal appearance.

During the first week following a cortical infarct, hypoattenuation and swelling become more marked, resulting in significant mass effect and clear demarcation of the infarct often with vivid gyral enhancement ⁶.

As time goes on, the swelling starts to subside and the cortex begins to increase in attenuation. This is believed to occur as the result of migration of lipid-laden macrophages into the infarcted tissue with proliferation of capillaries and a decrease in edema ^1-3. At 2 to 3 weeks following an infarct, the cortex regains near-normal density and imaging at this time can lead to confusion or missed diagnosis ^4,5. Fogging has been demonstrated in around 50% of cases ⁴.

If in doubt, the administration of IV contrast will demarcate the region of infarction ².

A similar phenomenon is also seen on T2 MRI sequences of the brain, and is believed to be due to similar cellular processes, as the timing is similar ³. It has been found to occur in approximately 50% of patients between 6 and 36 days (median 10 days) after onset of infarction ⁵.

References

Stroke and intracranial haemorrhage

stroke and intracranial hemorrhage
- ischemic stroke
  - general discussions
  - scoring and classification systems
  - signs
    - hyperdense MCA sign
    - MCA dot sign
  - by region
    - hemispheric infarcts
      - frontal lobe infarct
      - parietal lobe infarct
        Gerstmann syndrome
      - temporal lobe infarct
      - occipital lobe infarct
        
        alexia without agraphia syndrome: PCA
        
        cortical blindness syndrome (Anton syndrome): top of basilar or bilateral PCA
        
        Balint syndrome: bilateral PCA
      - internal capsule infarct
        ataxic hemiparesis syndrome: MCA perforators or basilar artery perforators
    - lacunar infarct
      - lacunar stroke syndromes
    - thalamic infarct
      - Déjerine-Roussy syndrome (thalamic pain syndrome): thalamoperforators of PCA
      - top of the basilar syndrome
    - striatocapsular infarct
    - cerebellar infarct
    - brainstem infarct
      - midbrain infarct
        
        Benedikt syndrome: PCA
        
        Claude syndrome: PCA
        
        Nothnagel syndrome: PCA
        
        Weber syndrome: PCA
      - pontine infarct
        
        Brissaud-Sicard syndrome
        
        facial colliculus syndrome
        
        Gasperini syndrome: basilar artery or AICA
        
        inferior medial pontine syndrome (Foville syndrome): basilar artery
        
        lateral pontine syndrome (Marie-Foix syndrome): basilar artery or AICA
        
        locked-in syndrome: basilar artery
        
        Millard-Gubler syndrome: basilar artery
        
        Raymond syndrome: basilar artery
      - medullary infarct
        
        Babinski-Nageotte syndrome
        
        hemimedullary syndrome (Reinhold syndrome)
        
        lateral medullary stroke syndrome (Wallenberg syndrome)
        
        medial medullary syndrome (Déjerine syndrome)
    - acute spinal cord ischemia syndrome
  - by vascular territory
  - treatment options
    - mechanical thrombectomy
  - complications
    - crossed cerebellar diaschisis
    - hemorrhagic transformation of an ischemic infarct
      - cerebral intraparenchymal hyperattenuations post thrombectomy
- intracranial hemorrhage
  - intra-axial hemorrhage
    - signs
      - CTA spot sign
    - by region or type
  - extra-axial hemorrhage

Article information

rID: 21647

System: Central Nervous System

Section: Signs

Synonyms or Alternate Spellings:

CT fogging phenomenon
MRI T2 fogging phenomenon
Fogging phenomena

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Cases and figures

Case 1: 2 days post onset of symptomsCase 1: 2 days post onset of symptoms

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Case 1: 9 days post onset of symptomsCase 1: 9 days post onset of symptoms

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