PCD is one of the most frequent paraneoplastic presentations frequently associated with active or subclinical gynecological, breast cancers, small cell lung cancer and Hodgkin’s lymphoma characterized by acute or subacute onset of cerebellar ataxia due to tumor induced autoimmunity against cerebellar antigens with generally unsatisfactory and limited treatment responses. Here we present a 48-year-old woman with a BRCA1 mutation who had Ductal carcinoma in situ (DCIS) and underwent bilateral mastectomy and Prophylactic total laparoscopic hysterectomy and bilateral salpingo-oophorectomy and later found to have and stage IV fallopian tube adenocarcinoma.  About six months after her surgery she began having neurological symptoms with difficulty writing, abnormal eye movements with progression of her symptoms with slurred speech.  She had CT head which was normal at presentation. On exam she had scanning speech with impaired eye movements, dyscoordination with finger to nose and heel to shin exercises.  She also had wide based ataxic gait with truncal ataxia.  About 2 months later her MRI brain revealed enhancement of the cerebellum. Her serum paraneoplastic panel was positive for anti-Yo antibodies. She was treated with high dose methylprednisolone x 3 days with no significant clinical improvement, followed by IVIG therapy x 6 cycles but continued to have severe cerebellar deficits with difficulty swallowing. She was then enrolled in intensive rehab therapy with both physical therapy and occupational services which provided her with maximum benefit. Thus her neurologic symptoms have remained stable since IVIG was completed and she remains ambulatory with one person assist for smaller distances and is able to go the gym to maintain her functionality. 

Stabilization of symptoms in patient with PCD requires a multidisciplinary approach through a combination of different IMT and aggressive rehabilitation. This case contributes to the understanding and treatment of PCD.