CT fogging effect with ischemic cerebral infarcts

Becker, H.; Desch, H; Häcker, H.; Pencz, A

doi:10.1007/bf00345723

Cited by 132 publications

(58 citation statements)

References 10 publications

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“…This is believed to occur as the result of migration into the infarcted tissue of lipid-laden macrophages as well as proliferation of capillaries, and decrease in the amount of oedema [1][2][3]. After 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].…”

Section: Discussionmentioning

confidence: 99%

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Fogging Effect in Strokes: Are We Aware of It?

Al-Jadiry¹,

Hasan²

2017

Med Case Rep

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Fogging effect is a transitory phenomenon of concealed cerebral infarction on computed tomography (CT). This effect is generally noticed within 2-3 weeks from the stroke onset.CT scan is the initial diagnostic imaging tool to demonstrate Ischemic strokes and ruling out/in hemorrhage.They usually demonstrate Hypo density on non-contrast CT scan. Iso-dense infarcts are misleading for radiologists and physicians as they might be interpreted as normal in spite of a clinically suspected stroke. Fogging reported to be seen in about 50% of the ischemic strokes.Knowledge of this effect is crucial to avoid misinterpretation or underestimation of this important finding and my guide further management especially if anticoagulants are being considered.

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Section: Discussionmentioning

confidence: 99%

“…The fogging effect was first described in 1979 by Becker et al [1]. It is defined as transient density equalization of the area of infarcted cerebral parenchyma in reference to normal parenchyma during the sub-acute phase of the infarct [2].…”

Section: Introductionmentioning

confidence: 99%

Fogging Effect in Strokes: Are We Aware of It?

Al-Jadiry¹,

Hasan²

2017

Med Case Rep

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“…Fogging effect was described for the first time in 1979 by Becker, et al [15], involving in brain infarct the transition from hypodensity to a zone with normal attenuation. It occurs through the combination of several processes including the invasion by macrophages loaded with lipids [16], capillary proliferation, leukocyte infiltration and extravasation of blood cells through the walls of the lesioned blood vessels [5].…”

Section: Casementioning

confidence: 98%

“…This effect is related with luxury perfusion, with increased blood flow concealing the radiological hypodensity in CT scans [3] associated with decreased brain edema [14,15]. Transient changes in the affected zones have also been described in MRI, where it can appear even from the sixth day after acute stroke [11].…”

Section: Casementioning

confidence: 99%

Confounding Imaging Findings in Subacute-Chronic Cerebral Infarction

Zm¹

2017

Austin J Cerebrovasc Dis & Stroke

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Imaging findings which appear during the course of subacute and chronic cerebral infarct and which can lead to confusion for diagnosis is presented in a series of six patients. These include: luxury perfusion, fogging effect, hemorrhagic transformation, Wallerian degeneration, diaschisis, laminar cortical necrosis and encephalomalacia with exvacuum dilation.Keywords: Subacute infarct; Chronic infarct; Luxury perfusion; Fogging effect; Hemorrhagic transformation; Wallerian degeneration; Diaschisis; Laminar cortical necrosis; Laminar cortical necrosis encephalomalacia; Exvacuum dilation are found, due to luxury perfusion effect ( Figure 1A,B). This effect confounds the real diagnostic of ischemic stroke and the images were interpreted as a brain tumor. Case 2Seventy-one-year-old female patient who presented sudden right hemiplejia and loss of consciousness. CT was performed 4 hours after the event and was considered normal. Due to unfavorable evolution, the study was repeated after 8 days (Figure 2A,B) and after 13 days ( Figure 2C). In A and B an infarct of the right MCA can be seen, with mass effect on the neighboring ventricle (which is collapsed) and slight displacement of the midline. Hyperdensity within the affected vascular territory follows the organization of gyri, contrasting with IntroductionAfter occlusion of a cerebral artery, imaging studies confirm cerebral infarction during hyper acute and acute phases [1][2][3]. This allows engaging in therapeutic decisions with the aim of reducing damaged tissue and thus the subsequent sequels.Nevertheless, imaging findings can occur during subacute and chronic phases of cerebral infarction that could disguise or mimic other neurological processes. Although these findings have been described in the literature, in many occasions they are overlooked and can originate confusion when conducting imaging diagnosis. Among these are: luxury perfusion, fogging effect, hemorrhagic transformation, Wallerian degeneration, diaschisis, laminar cortical necrosis and encefalomalacia with exvacuum dilation [4][5][6][7][8][9].During the subacute-chronic phase of cerebral infarction, many physicians can inform the images as negative and may even not associate these imaging findings with primary ischemic damage, interpreting them as independent events, thus modifying the diagnosis The object of this work was to describe the occurrence of these imaging findings in a series of six patients with cerebral infarction during the subacute-chronic phase. The description of the subjects is represented in Table 1. Case Presentation Case 1Three-year-old female patient with left hemiparesis and previous diagnosis of brain tumor. After a simple ( Figure 1A) and contrasted ( Figure 1B) CT scan performed between day 3-7 an increased density in the territory irrigated by the MCA and gyriform enhancement

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“…This phase is called "fogging" and the extent of an infarction may be underestimated. [4] By 2-3 months, the infarctions are recognized as areas of CSF density and are easily visible.…”

Section: Introductionmentioning

confidence: 99%

A Study on Yield and Usefulness of Non-Contrast Ct Brain Imaging in Acute Stroke at a Tertiary Care Institute in South India

Rangarajan¹,

Govindaraj²,

Chelladurai³

et al. 2016

jemds

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BACKGROUNDNon-enhanced CT scanning of the head remains the first-line diagnostic test for the emergency evaluation of acute stroke because of its speed, its convenient availability at most hospitals and its ability to sensitively depict intracranial haemorrhage. [1] This is an observational study done to ascertain the yield and usefulness of non-contrast CT brain imaging in acute stroke in a tertiary care centre.

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CT fogging effect with ischemic cerebral infarcts

Cited by 132 publications

References 10 publications

Fogging Effect in Strokes: Are We Aware of It?

Fogging Effect in Strokes: Are We Aware of It?

Confounding Imaging Findings in Subacute-Chronic Cerebral Infarction

A Study on Yield and Usefulness of Non-Contrast Ct Brain Imaging in Acute Stroke at a Tertiary Care Institute in South India

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