ABSTRACT Malignancy related hypercoagulobility can manifest as acute arterial infarction, non-bacterial thrombotic endocarditis and thrombophlebitis. Rarely, ischemic stroke may be first symptom for a systemic occult cancer. We presented 62-year-old man who had recurrent stroke as the initial manifestation of an occult neoplastic process. Subsequently, the patient had venous thrombotic disease that led to the diagnosis of the malignancy. Conclusions: Acute or sub-acute multiple ischemic stroke may be the first manifestation of in an occult cancer.
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