Summary

An elderly man presented to the emergency department with symptoms of a left-sided weakness. A CT of the brain scan showed an abnormality, and he was diagnosed with a stroke and admitted to the stroke unit. The stroke consultant reviewed him the next morning; a detailed history was acquired and imaging reviewed. As a result of the history of neurological symptoms, a diagnosis of malignancy was suspected and an MRI of the brain was ordered. This did not show a stroke but suggested a mass lesion. A CT of the chest, abdomen and pelvis was ordered to rule out a primary cause. Unfortunately, this showed widespread metastatic carcinoma with a left upper lobe primary (T4 N3 M1b). This was confirmed on histology. The patient died soon after the diagnosis.