CT-Proven Ischaemic Stroke as the First Manifestation of Occult Lung Cancer

Cancer is associated with a higher risk of stroke, and in rare cases stroke can be the first manifestation of occult neoplasia. We present the case of a 74-year-old woman hospitalized for ischaemic stroke with multiple cerebral infarctions in several vascular territories. The exclusion of other aetiologies and the simultaneous presence of thromboembolic events in other organs raised the suspicion of a hypercoagulable state, which upon investigation revealed occult neoplasia of the lung. There was rapid deterioration, with recurrent thrombotic events despite anticoagulation, which eventually led to the patient’s death. LEARNING POINTS: Stroke can be the first manifestation of occult neoplasia. In the presence of cryptogenic stroke, high D-dimers, multiple brain infarctions in different vascular territories and thromboembolic events in other organs, the possibility of hidden neoplasia should be considered. Anticoagulation in disseminated intravascular coagulation is insufficient if the primary disease is not treated.