Fogging phenomenon (cerebral infarct)

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 .

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 a number of processes occurring simultaneously including the migration of lipid-laden macrophages and leukocytes into the infarcted tissue, proliferation of capillaries, extravasation of red blood cells out of damaged capillaries and a decrease in edema .

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 . Fogging has been demonstrated in around 50% of cases .

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

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 . It has been found to occur in approximately 50% of patients between 6 and 36 days (median 10 days) after the onset of infarction .

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