We present a clinical case of cancer-associated ischemic stroke in a 70-year-old patient with metastatic sigmoid colon cancer. The patient was admitted to the hospital in the hyperacute stage of ischemic stroke due to thrombosis of the left middle cerebral artery, complicated by severe global aphasia and right-sided hemiplegia (NIHSS — 20). Despite the high risk of hemorrhagic complications associated with underlying malignancy, systemic thrombolysis with alteplase was successfully administered; however, hemorrhagic transformation subsequently occurred. Early comprehensive rehabilitation and adjunctive therapy with Cerebrolysin (30 ml/day) significantly reduced neurological deficits. One month after the stroke, the patient exhibited near-complete motor recovery and substantial improvement in speech function without complications during anticoagulant therapy with apixaban. This case highlights the importance of early diagnosis and an integrated approach to the management of stroke in oncological patents.