A 68 year old male, chronic smoker and alcoholic presented to medicine OP with complaint of persistent vomiting of one month duration. He had a bad headache during these days. Clinical examination was essentially normal except for clubbing. Lab parameters were within normal limits except an elevated ESR. During detailed evaluation he gave history of dry cough of two month duration. Chest X-ray was taken and showed a peripheral opacity. CECT chest showed evidence of carcinoma lung. What could be the cause for his persistent vomiting?

More than half of all patients diagnosed with lung cancer present with advanced disease at the time of diagnosis. The prototypical lung cancer patient is a current or former smoker of either sex, usually in the seventh decade of life. A history of chronic cough with or without hemoptysis in a current or former smoker. Here the patient has advanced disease. As he was cmplaining of head ache and vomiting and considering the fact that brain mets are not uncommon in bronchogenic carcinoma, the first possibility in this setting would be bronchogenic carcinoma with brain metastasis.