title: Frequent Ischemic Stroke as First Manifestation of Occult Colon Cancer: A Rare Case.
abstract: BACKGROUND
  It is rare that occult cancer presents with frequent ischemic stroke as the sole manifestation.
  
  
  METHODS
  We report the case of a 46-year-old man with frequent stroke in different vascular areas, with diabetes and hypercholesterolemia identified as risk factors. The results of biochemistry, young stroke profiles, trans-cranial and extra-cranial carotid Doppler, and 24-h Holter electrocardiogram were within normal limits. The reports of transthoracic echocardiography (TTE) were unremarkable. Finally, a multi-detector computed tomography (MDCT) demonstrated a thrombus in the posterior-lateral aspect of the left atrium and non-bacterial thrombotic endocarditis (NBTE) was suspected. The results motivated the survey for occult cancer, and adenocarcinoma of the ascending colon was confirmed on colonoscopy pathology.
  
  
  CONCLUSIONS
  We suggest that evaluating the possibility of occult cancer should be emphasized in patients of frequent stroke refractory to therapy, whether risk factors are already identified or not. Furthermore, we assume MDCT can be an alternative way to detect cardiogenic embolic sources in stroke patients.
authors.affiliation: Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
authors.forename: Chia-Chan
authors.initials: CC
authors.lastname: Tsai
authors.affiliation: Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
authors.forename: Meng-Ni
authors.initials: MN
authors.lastname: Wu
mesh_terms: D000230:Adenocarcinoma / Q000150:complications* / Q000175:diagnosis; D002545:Brain Ischemia / Q000175:diagnosis / Q000209:etiology*; D003110:Colonic Neoplasms / Q000150:complications* / Q000175:diagnosis; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D014057:Tomography, X-Ray Computed