Metastatic brain tumor manifesting as lacunar syndrome in adults

Lacunar syndrome can be an initial manifestation of the metastatic brain tumor in young adults. Two patients were encountered with previously undiagnosed lung cancer, one with anaplastic carcinoma and the other with adenocarcinoma. A neurologic syndrome occurred in the morning with unusual headache and stroke-like episodes, presenting an acute ataxic hemiparesis and a pure motor hemiparesis, respectively. Papilloedema was a universal finding. The headache and neurologic deficits responded rapidly to glucocorticoid. A preexisting intracranial mass with an outburst of brain edema is thought to be the mechanism in this situation.