Multiple hemorrhagic strokes from DIC associated with occult large cell carcinoma

Matthew A. Koenig, Joseph Maleszewski, Brad Winters

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Background and Purpose: Multiple hemorrhagic strokes are a rare presentation of paraneoplastic disseminated intravascular coagulation (DIC). We present a case of DIC occurring in a patient with occult large cell carcinoma. Summary of Case: A 77-year old Asian-American man presented with 1 month of vision disturbance followed by acute onset of left hemiparesis and encephalopathy. He was found to have three strokes of varying ages, and was placed on aspirin and clopidogrel. He returned 4 days later with hemorrhagic conversion of the strokes and laboratory abnormalities suggestive of DIC. Over the hospital course, he suffered recurrent ischemic strokes and intracerebral hemorrhages despite management of his coagulopathy. On autopsy, an occult large cell carcinoma was found in the hilar lymph nodes, as well as multiple intravascular thrombi. Conclusions: Recurrent hemorrhagic strokes associated with DIC may be the initial presentation of occult malignancy. Although adenocarcinoma is classically associated with paraneoplastic DIC, this case demonstrates that large cell carcinoma may also be implicated.

Original languageEnglish (US)
Pages (from-to)210-212
Number of pages3
JournalNeurocritical care
Issue number3
StatePublished - Dec 2006


  • Disseminated intravascular coagulation
  • Intracerebral hemorrhage
  • Ischemic stroke
  • Large cell carcinoma
  • Paraneoplastic

ASJC Scopus subject areas

  • Clinical Neurology
  • Critical Care and Intensive Care Medicine


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