Introduction/Background This report details the cases of two women – one in her 70s and one in her 80s - who developed unexplained cerebellar symptoms, which eventually led to the investigation and discovery of underlying gynaecologic malignancy in one, while the investigations for the second are still ongoing.

Paraneoplastic Neurological Syndromes (PNS) describe a wide variety of conditions where neurological symptoms are indirectly caused by an underlying malignancy via immune-medicated pathogenesis. This is a rare presentation of malignancy and is extremely susceptible to misdiagnosis. One such PNS is paraneoplastic cerebellar ataxia, which is most often a result of gynaecologic cancer.

Methodology Two patients were referred from their local or community hospitals to the neurology department of a large tertiary centre with ongoing neurological symptoms of unknown cause. They underwent surgical and histological investigation for underlying malignancy

Results One patient was found to have Stage 1a serous type tubal malignancy. The second patient has been so far only found to have incidental hyperplasia with no malignancy.

Conclusion PNS is a rare and often debilitating disorder caused by underlying malignancy, which may not have yet been diagnosed. Prompt recognition of PNS may lead to improved outcomes for patients due to early identification of malignancy. Further work is needed to promote understanding of PNS among clinicians and to develop guidelines to aid with diagnosis and correlation of the underlying malignancy.

Disclosures None.