Disclosures: Alethea J. Appavu, DO: No financial relationships or conflicts of interest

Case Diagnosis: A 56 year old male with medical history of hypertension, hyperlipidemia, and seizure disorder who presented with extreme fatigue and found with multiple infarcts.

Case Description: On presentation, MRI revealed subarachnoid hemorrhage, and infarct in the left superior frontal gyrus and splenium of corpus callosum. He had right sided deficits in the lower extremity most notable proximally. Hospital course was complicated by fevers and altered mental status.

Setting: Acute tertiary hospitalAssessment/

Results: Patient had a repeat MRI 2 weeks later which showed progression of the infarcts and underwent extensive work up which was unremarkable. On repeat MRI after another week, there was complete resolution of the infarcts, however neurological deficits remained. This patient was admitted to rehabilitation (despite the lack of radiographic evidence) at total assist and was discharged at supervision or higher in ambulation and ADLs.

Discussion: There have been reports of a “fogging effect” where the region of an infarct regains a normal appearance. The fogging effect can happen between 6-36 days after the initial symptoms and is also associated with a better prognosis. This effect was first noted on MRI in 1991. Fogging is actually common occurring in 50-54% of all stroke cases. Reappearance of the infarct on imaging can occur 3-6 months later. Interestingly, the neurological and functional deficits remain.

Conclusion: The “fogging effect” is more common than we experience as it is not standard to obtain imaging frequently after a stroke is diagnosed unless there are new neurological findings. What makes this case stand out is the importance of the clinical diagnosis rather than relying on the radiographical diagnosis and evidence. The lack of radiographic evidence should not prevent someone benefitting from acute rehabilitation with obvious neurological deficits suggesting an infarct. Our consult evaluation should consider the clinical case and the functional deficits, especially when the fogging effect is more common than seen.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/the-case-report-of-the-disappearing-infarct/