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Background Immune checkpoint inhibitors (ICI) demonstrate significant efficacy in the treatment of cancer but are commonly associated with immune related adverse events. Neurological toxicity is associated with significant morbidity and mortality but further understanding of its presentation and management is required.Methods Retrospective case note review of Immunotherapy-neurotoxicity (IO-neurotox) presenting to oncology and neurology-lead services in five regional centres across the UK between 2019 and 2024. Data was collected by consensus proforma with national ethical approval.Results 108 patients (male, n=63;58.3%) were identified. Skin was the most common site of primary malignancy (n=67;62%). Pembrolizumab (n=44;40.7%) and Ipilimumab/Nivolumab in combination (n=44;40.7%) were the most common treatments with a median time to IO-neurotox of 53 days (range 2-574) and 2 treatment cycles (1-25). The most common presentations included neuropathy/neuritis (n=37;34.3%), myasthenia/myositis/myocarditis (MMM; n=10;9.3%), myasthenia gravis (n=8;7.4%), vestibulitis (n=7;6.5%) and encephalitis (n=7;6.5%). Ninety-six (88.9%) received steroids, 24(22.2%) IVIg and 16 underwent PLEX(14.8%). Symptom resolution occurred in 47(43.5%). Treatment rechallenge occurred in 18(16.7%) patients with known recurrence of IO-neurotox in 1(5.6%).Conclusion A range of neurological presentation may be observed following ICI. Despite treatment, only half of all patients experience complete resolution although treatment rechallenge is not related to IO-neurotox recurrence.schroederb2@cardiff.ac.uk