Recurrent stroke in a patient of lung cancer without pulmonary mass

RATIONALE Repeated occurring stroke in short intervals with hypercoagulability is unusual so in such cases the conventional vascular risk factors might not be the causes of stroke. PATIENT CONCERNS We have presented a case of 60-year-old male presenting with recurrent stroke due to thrombophilia. DIAGNOSES Lung cancer was detected by superficial lymph nodes ultrasound and further pathological examination. INTERVENTIONS The patient suffered a recurrent stroke and he had persistently high level of D-dimer which suggested the diagnosis of thrombophilia, thus, he was treated with low-molecular-weight heparin. Unfortunately, the treatment was not effective for the patient and he died before any other treatments could be administered. OUTCOMES Despite anticoagulant therapy, the patient suffered multiple episodes of stroke and ultimately died. LESSONS This case of recurrent stroke with coagulation disorders without evidence of cancer in imaging and blood test is rare. So in a stroke patient, we should consider malignancy or metastasis as a differential diagnosis as it may be the first manifestation of active cancer elsewhere.