The early fogging effect in cerebral infarction – a case report and review of the literature

BACKGROUND: The fogging effect is a well-known phenomenon usually seen two to three weeks post stroke, characterized by a pseudonormalization of the infarcted tissue. CASE PRESENTATION: A 62-year-old patient underwent emergent thoracic endovascular aortic repair (TEVAR) due to a Stanford Type B aortic dissection. Post-intervention dual antiplatelet therapy and systemic anticoagulation were administered. The following day, the patient developed acute neurological deficits. Cranial CT and perfusion imaging demonstrated an infarction in the left posterior inferior cerebellar artery territory, and conservative management was pursued. A follow-up CT scan 27 h later revealed an isodense area within the infarcted region consistent with the fogging effect. CONCLUSION: Our case demonstrated this fogging effect at an unusually early timepoint. We hypothesize that systemic therapeutic anticoagulation together with dual antiplatelet therapy may have contributed to the early onset of fogging. This case highlights the limitations of non-contrast CT in stroke assessment and underscores the importance of multimodal imaging and awareness of this phenomenon.