Cerebral infarction (CI) severely affects the prognosis of patients with malignancy. The aim of the study was to compare the pathology of CI between cases with and without malignancy focusing on intracranial Mönckeberg’s atherosclerosis. Among 778 autopsy cases of craniotomy, 53 cases of “cerebral infarction without malignancy group” (CI group), 50 cases of “malignant tumor without CI group” (MT group), and 39 cases of “cerebral infarction with malignancy group” (CM group) were identified. Mönckeberg’s atherosclerosis was mainly found in the basal ganglia and its prevalence in the CM group (38.5%) was significantly higher than in the MT group (12.0%, p = 0.005), and apparently higher than in the CI group (18.9%, p = 0.057). The CI group was significantly older, had higher BMIs, and a greater prevalence of hypertension and atrial fibrillation compared to the CM group. In addition, the prevalence of chronic renal disease was significantly lower in the CM group (2.6%, p = 0.012) than in the CI group (20.8%). Our results indicated that Mönckeberg’s atherosclerosis was often found in the basal ganglia of CM cases and that intracranial Mönckeberg’s atherosclerosis is a potential risk factor for CI in patients with advanced stage malignancy.

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