Multifocal strokes as the presentation of occult lung cancer

Cancer patients are hypercoagulable through a variety of mechanisms and are at significant risk for ischemic stroke. Though usually occurring in the later stages of neoplastic disease, stroke can rarely be the first manifestation of an occult malignancy. We report a 46-year-old woman who presented with multiple cerebral infarctions in numerous vascular distributions, refractory to anticoagulation, and associated with systemic thromboses. These atypical features prompted a malignancy evaluation which revealed an occult lung adenocarcinoma. Our patient had a rapidly deteriorating course with recurrent strokes despite numerous anti-platelet and anti-coagulant agents, and was only responsive to chemotherapy aimed at the underlying cancer.