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: Case report  Saudi Arabia

[In Press] Metastatic Lung Adenocarcinoma: Unusual Presentation with Focal Neurological Deficit

Unknown etiology, Unusual clinical course, Challenging differential diagnosis, Diagnostic / therapeutic accidents, Management of emergency care

Dunya N. Alfaraj1ABDEF, Abdulaziz M. Al Dahlawi2ABDEF, Mishael M. AlObaid3ABDEF, Talal R. Aldukhayyil3ABDEF, Dina A. Al Rumaih3ABDEF

Am J Case Rep In Press; DOI:   :: ID: 936342

Available online: , In Press, Corrected Proof

Publication in the "In-Press" formula aims at speeding up the public availability of the pending manuscript while waiting for the final publication. The assigned DOI number is active and citable. The availability of the article in the Medline, PubMed and PMC databases as well as Web of Science will be obtained after the final publication according to the journal schedule


Sudden focal neurologic deficits have a high index of suspicion of stroke. It is crucial to investigate potential underlying causes of sudden neurological deficit in the Emergency Department (ED) to enhance better recognition and proper care.
A 63-year-old man presented to the ED with left-sided weakness and headache of a 2-week duration. Ischemic stroke was preliminarily diagnosis in the ED. Brain computed tomography (CT) showed an abnormality in the right parietal lobe. A chest X-ray showed right lung opacity, suggesting a mass in the right upper lobe of the lung. Subsequently, malignancy was suspected. Brain magnetic resonance imaging (MRI) showed lesions in the right temporal and right parietal region. CT scans of the chest, abdomen, and pelvis were ordered to identify the primary source of malignancy. Multiple nodules within the lungs and liver were found; a biopsy was taken from the nodules and sent to the Pathology Laboratory. Final impression made after the results was primary lung adenocarcinoma with brain and liver metastasis. The patient was referred to Palliative Care team by the Oncology team after malignancy workup to get the proper attention.
A hypodense area in CT/MRI with unilateral weakness and headache does not necessarily mean that there is an underlying stroke. However, it can represent brain metastasis. In this case report, we aim to increase awareness that hypodensity in the brain could represent brain metastasis, not necessarily simple ischemic stroke. Therefore, further workup should be done to avoid missed diagnoses, as the approach is different.

Keywords: Diagnosis, Differential; Emergency Medical Services; Ischemic Stroke; Adenocarcinoma


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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923