A patient who had a primary lung carcinoma in remission but had a solitary metastatic lesion to the cerebellum was referred to the neurosurgery service. He was noted to be thrombocytopenic, and further hemostatic evaluation revealed chronic disseminated intravascular coagulation. He was treated with heparin and platelet transfusions. Although the fibrinogen levels improved, the thrombocytopenia persisted. Four weeks after admission, repeat chest x-ray films and tomograms indicated progressing metastatic nodules. A review of the literature reveals a variety of hemostatic defects associated with tumor metastatic to the brain. This current case indicates the need for careful hemostatic evaluation in all patients with brain lesions.