Ischaemic stroke as the first presentation of occult squamous cell cancer

A 39 years old female presented with sudden onset of left sided weakness and CT scan brain confirmed an ischaemic stroke. Extensive investigations looking for the underlying cause were un-rewarding. She presented few days later with confusion and fever and was found to have multiple new cerebral infarcts, disseminated intravascular coagulation, rectal mass and liver metastases. Biopsy of metastatic liver lesion identified the primary tumour to be of squamous cell origin. Such a rare presentation as ischaemic stroke of a very rare squamous cell carcinoma of rectum has not been reported before