What happened, in summary

A 76-year-old man developed dysarthria and left-sided weakness from a right cerebral infarction. Cardiac and coagulation evaluation did not identify another embolic source, while chest CT showed a left hilar lung tumor. The stroke was attributed to Trousseau syndrome, a cancer-associated thrombotic complication. He received continuous intravenous heparin adjusted to maintain the target clotting time and edaravone for brain protection. Evaluation found no distant metastases. The lung cancer was classified clinically as stage IIIA, cT4N1M0, with pulmonary-artery involvement and hilar nodes. After his neurologic symptoms improved, the team chose surgery before chemotherapy. A left pneumonectomy was completed in 219 minutes with 130 mL blood loss. Pathology confirmed a 77 mm adenocarcinoma, pT4N1M0, stage IIIA. Warfarin was started on postoperative day 1, and home oxygen was introduced before discharge on day 11. His recovery was uncomplicated. Adjuvant chemotherapy was not given because his performance status remained poor. At 23 months after surgery, he had no recurrence and continued outpatient surveillance. Control of the primary lung cancer together with anticoagulation allowed a favorable course despite presentation with a serious cancer-associated stroke.