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Neurological manifestations as the sole presenting symptom of a haematological malignancy are a rare occurrence and pose diagnostic challenges. We present a case of a young man with acute onset neurology, who was ultimately diagnosed with neurolymphomatosis (NL) and NK-T cell lymphoma.A 39 year old male presented with right arm weakness and paraesthesia after a surfing injury in May 2024. Initially thought to be a traumatic myelopathy or plexopathy, MRI cervical spine did not reveal any abnormality. He had no abnormal cell counts, no B-symptoms and no previous malignancy. MRI brachial plexus, FDG-PET and nerve conduction studies were in keeping with a lower brachial plexopathy, and following cerebrospinal fluid analysis, NK-T cell lymphoma was diagnosed within a week of admission. A synchronous metastatic papillary thyroid cancer was also discovered on investigation but was not related to his presentation. He has now completed intrathecal and systemic chemotherapy, immunotherapy and craniospinal radiotherapy with a planned matched sibling bone marrow transplant in March 2025.Neurolymphomatosis is a rare condition of direct neural invasion by lymphoma cells.1 There is limited understanding of natural history with most literature from case reports and series. The largest meta-analysis published in 2024 investigated 559 cases from articles published from 1951–2022.2 Median overall survival was 12-months, and diagnosis was elusive with time from first symptom onset to diagnosis 4 to 6 months.2 This case highlights the importance of a broad differential diagnosis, and brings evidence that Neurology can provide investigations that can lead to timely diagnoses.References Grisariu S, Avni B, Batchelor TT, et al. Neurolymphomatosis: an international primary CNS lymphoma collaborative group report. Blood 2010;115(24):5005–5011. doi:10.1182/blood-2009–12-258210Xu E, Ho Q, Liu A, et al. The natural history of neurolymphomatosis. BJC Reports 2024;2(34). doi.org/10.1038/s44276–024-00053-x