Journal of Neuro-Oncology

, Volume 85, Issue 3, pp 307–309 | Cite as

Multifocal strokes as the presentation of occult lung cancer

  • Babak B. Navi
  • Lisa M. DeAngelis
  • Alan Z. Segal
Clinical-Patient Studies


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.


Cancer Hypercoagulability Lung cancer Non-bacterial thrombotic endocarditis Stroke 


  1. 1.
    Graus F, Rogers LR, Posner JB (1985) Cerebrovascular complications in patients with cancer. Medicine 64:16–35PubMedCrossRefGoogle Scholar
  2. 2.
    Cestari DM, Weine DM, Panageas KS, Segal AZ, DeAngelis LM (2004) Stroke in patients with cancer: Incidence and etiology. Neurology 62:2025–2030PubMedGoogle Scholar
  3. 3.
    Rogers LR, Cho ES, Kempin S, Posner JB (1987) Cerebral infarction from non-bacterial thrombotic endocarditis. Clinical and pathological study including the effects of anticoagulation. Am J Med 83:746–756PubMedCrossRefGoogle Scholar
  4. 4.
    Cornuz J, Bogousslavsky J, Schapira M, Regli F, Camenzind E (1988) Ischemic stroke as the presenting manifestation of localized systemic cancer. Schweiz Arch Neurol Psychiatr 139:5–11PubMedGoogle Scholar
  5. 5.
    Borowski A, Ghodsizad A, Gams E (2005) Stroke as a first manifestation of ovarian cancer. J Neuro-Oncol 71:267–269CrossRefGoogle Scholar
  6. 6.
    Herrera de Pablo P, Esteban Esteban E, Gimenez Soler JV, Pareja Martinez A, Moscoso del Prado J (2004) Nonbacterial thrombotic endocarditis as initial event of lung cancer. An Med Interna 21:495–497Google Scholar
  7. 7.
    Kooiker JC, Maclean JM, Sumi SM (1976) Cerebral embolism, marantic endocarditis, and cancer. Arch Neurol 33:260–264PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Babak B. Navi
    • 1
  • Lisa M. DeAngelis
    • 2
  • Alan Z. Segal
    • 1
  1. 1.Weill-Cornell Medical CenterNew YorkUSA
  2. 2.Department of NeurologyMemorial Sloan-Kettering Cancer CenterNew YorkUSA

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